Healthcare Provider Details

I. General information

NPI: 1992031272
Provider Name (Legal Business Name): KIMBERLY MCMULLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 OAK ST
SAN FRANCISCO CA
94102-5610
US

IV. Provider business mailing address

56 N CLAREMONT ST
SAN MATEO CA
94401-3216
US

V. Phone/Fax

Practice location:
  • Phone: 415-626-5199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: