Healthcare Provider Details

I. General information

NPI: 1679426720
Provider Name (Legal Business Name): AVA MARIE KINKELAAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 S ANITA DR STE 201
ORANGE CA
92868-3346
US

IV. Provider business mailing address

265 S ANITA DR STE 201
ORANGE CA
92868-3346
US

V. Phone/Fax

Practice location:
  • Phone: 714-410-3505
  • Fax: 714-410-3500
Mailing address:
  • Phone: 714-410-3505
  • Fax: 714-410-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: