Healthcare Provider Details

I. General information

NPI: 1326344268
Provider Name (Legal Business Name): AMALIA KIMBER C.N.M., RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SONOMA AVE STE 202
SANTA ROSA CA
95405-4813
US

IV. Provider business mailing address

1111 SONOMA AVE STE 202
SANTA ROSA CA
95405-4813
US

V. Phone/Fax

Practice location:
  • Phone: 808-652-6744
  • Fax: 707-575-3941
Mailing address:
  • Phone: 808-575-1626
  • Fax: 707-575-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number235941
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7772
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number2322
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number66490
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: