Healthcare Provider Details

I. General information

NPI: 1871572008
Provider Name (Legal Business Name): KIMBERLY S MORELAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 SOQUEL DR STE 1
SANTA CRUZ CA
95065-1716
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 831-465-5440
  • Fax: 831-462-2017
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG171306
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number263390-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number263390-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: