Healthcare Provider Details

I. General information

NPI: 1316441512
Provider Name (Legal Business Name): KIMBERLY CORBETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 S DE ANZA BLVD STE 105
SAN JOSE CA
95129-3553
US

IV. Provider business mailing address

935 CALLE DIABLO CT
BRENTWOOD CA
94513-6516
US

V. Phone/Fax

Practice location:
  • Phone: 408-320-5139
  • Fax:
Mailing address:
  • Phone: 925-642-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-45316
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: