Healthcare Provider Details

I. General information

NPI: 1376875872
Provider Name (Legal Business Name): KIMBERLY M OPITZ MPA, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY M ACERES MPA, PA-C

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3273 CLAREMONT WAY SUITE 100
NAPA CA
94558-3328
US

IV. Provider business mailing address

PO BOX 2059
NAPA CA
94558-3328
US

V. Phone/Fax

Practice location:
  • Phone: 707-254-7117
  • Fax: 707-265-6435
Mailing address:
  • Phone: 707-254-7117
  • Fax: 707-265-6435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: