Healthcare Provider Details

I. General information

NPI: 1689440018
Provider Name (Legal Business Name): MIKAYLA KAY RIMSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 EDGEWOOD DR
PALO ALTO CA
94303-2822
US

IV. Provider business mailing address

985 PARKVIEW DR UNIT 20
TUSCALOOSA AL
35401-4100
US

V. Phone/Fax

Practice location:
  • Phone: 650-387-2053
  • Fax:
Mailing address:
  • Phone: 650-387-2053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: