Healthcare Provider Details

I. General information

NPI: 1639953441
Provider Name (Legal Business Name): MARGARET KATHLEEN KIMBALL RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5552 CRIBARI CIR
SAN JOSE CA
95135-1314
US

IV. Provider business mailing address

5552 CRIBARI CIR
SAN JOSE CA
95135-1314
US

V. Phone/Fax

Practice location:
  • Phone: 650-773-0372
  • Fax:
Mailing address:
  • Phone: 650-773-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number431825
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number431825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: