Healthcare Provider Details

I. General information

NPI: 1073710489
Provider Name (Legal Business Name): KIMBERLY ANNE BEKEMEIER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13010 HESPERIA RD SUITE 600
VICTORVILLE CA
92395-5837
US

IV. Provider business mailing address

18564 US HIGHWAY 18 STE 105
APPLE VALLEY CA
92307-2320
US

V. Phone/Fax

Practice location:
  • Phone: 760-881-3717
  • Fax: 760-881-3720
Mailing address:
  • Phone: 760-242-7777
  • Fax: 760-242-2658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A10741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: