Healthcare Provider Details

I. General information

NPI: 1700923133
Provider Name (Legal Business Name): KIMBERLY LIMYOU DAVIS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 ATLANTA AVE D3
RIVERSIDE CA
92507-7419
US

IV. Provider business mailing address

1827 ATLANTA AVE D3
RIVERSIDE CA
92507-7419
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-8000
  • Fax: 951-955-8010
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number219798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: