Healthcare Provider Details

I. General information

NPI: 1245979889
Provider Name (Legal Business Name): KIMBERLY JONES MSOP, CPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY PETERSEN MSOP, CPO

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 W REDLANDS BLVD STE 103
REDLANDS CA
92373-3127
US

IV. Provider business mailing address

1849 W REDLANDS BLVD STE 103
REDLANDS CA
92373-3127
US

V. Phone/Fax

Practice location:
  • Phone: 909-798-5853
  • Fax:
Mailing address:
  • Phone: 909-798-5853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO03850
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO03850
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: