Healthcare Provider Details

I. General information

NPI: 1760241574
Provider Name (Legal Business Name): KIMBERLY ROSE BARR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S PACIFIC COAST HWY STE 112
REDONDO BEACH CA
90277-3339
US

IV. Provider business mailing address

220 S PACIFIC COAST HWY STE 112
REDONDO BEACH CA
90277-3339
US

V. Phone/Fax

Practice location:
  • Phone: 213-262-4392
  • Fax:
Mailing address:
  • Phone: 213-394-2486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: