Healthcare Provider Details

I. General information

NPI: 1467047050
Provider Name (Legal Business Name): KIMBERLY RAHIMIAN OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 W VISTA WAY
VISTA CA
92083-2112
US

IV. Provider business mailing address

11840 PASEO LUCIDO UNIT 57
SAN DIEGO CA
92128-6229
US

V. Phone/Fax

Practice location:
  • Phone: 858-769-6031
  • Fax:
Mailing address:
  • Phone: 619-399-9037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number21528
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: