Healthcare Provider Details

I. General information

NPI: 1093650681
Provider Name (Legal Business Name): SIERRA MORGAN KIMMELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S KING RD
SAN JOSE CA
95122-2139
US

IV. Provider business mailing address

1150 S KING RD
SAN JOSE CA
95122-2139
US

V. Phone/Fax

Practice location:
  • Phone: 408-622-9222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB840655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: