Healthcare Provider Details

I. General information

NPI: 1972079036
Provider Name (Legal Business Name): KIMBERLY PIRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 FOLSOM BLVD STE 195
SACRAMENTO CA
95826-3231
US

IV. Provider business mailing address

7819 MARWOODS CT
SACRAMENTO CA
95828-4887
US

V. Phone/Fax

Practice location:
  • Phone: 916-382-4447
  • Fax:
Mailing address:
  • Phone: 209-471-7734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: