Healthcare Provider Details

I. General information

NPI: 1770829905
Provider Name (Legal Business Name): KIMBERLEY ANN SPRINGER NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2012
Last Update Date: 12/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42730 CAMELOT RD
TEMECULA CA
92592-7117
US

IV. Provider business mailing address

42730 CAMELOT RD
TEMECULA CA
92592-7117
US

V. Phone/Fax

Practice location:
  • Phone: 951-553-5810
  • Fax:
Mailing address:
  • Phone: 951-553-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number120531071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: