Healthcare Provider Details

I. General information

NPI: 1104115930
Provider Name (Legal Business Name): KIMI NICOLE VERILHAC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 12/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5570 OVERLAND AVE STE 101
SAN DIEGO CA
92123-1215
US

IV. Provider business mailing address

5029 HARVILLE RD
SANTA ROSA CA
95409-2517
US

V. Phone/Fax

Practice location:
  • Phone: 858-694-2895
  • Fax:
Mailing address:
  • Phone: 970-290-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberA134515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: