Healthcare Provider Details

I. General information

NPI: 1356121958
Provider Name (Legal Business Name): KRISTAN FIMBRES AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 W HILLCREST DR STE 100
THOUSAND OAKS CA
91360-7820
US

IV. Provider business mailing address

2876 SYCAMORE DR STE 303
SIMI VALLEY CA
93065-1550
US

V. Phone/Fax

Practice location:
  • Phone: 805-379-0824
  • Fax: 805-507-9768
Mailing address:
  • Phone: 805-583-8698
  • Fax: 805-507-9768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU3825
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: