Healthcare Provider Details

I. General information

NPI: 1861996498
Provider Name (Legal Business Name): KIMBERLY CAROL TOWNSEND CBD, CPD, CBC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5876 FISHBURNE AVE
SAN JOSE CA
95123-3821
US

IV. Provider business mailing address

5876 FISHBURNE AVE
SAN JOSE CA
95123-3821
US

V. Phone/Fax

Practice location:
  • Phone: 708-374-4222
  • Fax:
Mailing address:
  • Phone: 708-374-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: