Healthcare Provider Details

I. General information

NPI: 1952899460
Provider Name (Legal Business Name): KIM NICOLA BROWN R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24525 TOWN CENTER DR
VALENCIA CA
91355
US

IV. Provider business mailing address

23345 MCBEAN PKWY
VALENCIA CA
91355
US

V. Phone/Fax

Practice location:
  • Phone: 661-200-2300
  • Fax: 661-200-2308
Mailing address:
  • Phone: 661-200-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number912674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: