Healthcare Provider Details

I. General information

NPI: 1215173653
Provider Name (Legal Business Name): KIMBERLY ANN BLUFF FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3202
US

IV. Provider business mailing address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3202
US

V. Phone/Fax

Practice location:
  • Phone: 760-773-2038
  • Fax: 760-674-3857
Mailing address:
  • Phone: 760-773-2038
  • Fax: 760-674-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: