Healthcare Provider Details

I. General information

NPI: 1205248218
Provider Name (Legal Business Name): KIMBERLY AGUPITAN POWERS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY BALANGUE AGUPITAN CRNA

II. Dates (important events)

Enumeration Date: 05/24/2014
Last Update Date: 06/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44139 MONTEREY AVE STE B
PALM DESERT CA
92260-8700
US

IV. Provider business mailing address

128 TESORI DR
PALM DESERT CA
92211-0799
US

V. Phone/Fax

Practice location:
  • Phone: 760-773-4411
  • Fax:
Mailing address:
  • Phone: 909-223-8766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number656241
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: