Healthcare Provider Details

I. General information

NPI: 1447810858
Provider Name (Legal Business Name): KIMBERLY WULFERT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PALMA DR STE 276
VENTURA CA
93003-6451
US

IV. Provider business mailing address

226 W OJAI AVE STE 101
OJAI CA
93023-3278
US

V. Phone/Fax

Practice location:
  • Phone: 805-320-9361
  • Fax:
Mailing address:
  • Phone: 805-320-9361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY11065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: