Healthcare Provider Details

I. General information

NPI: 1861285041
Provider Name (Legal Business Name): KIMBERLY OBREGON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 WELLSPRING AVE SE STE D
RIO RANCHO NM
87124-4956
US

IV. Provider business mailing address

8100 WYOMING BLVD NE STE 406
ALBUQUERQUE NM
87113-1946
US

V. Phone/Fax

Practice location:
  • Phone: 505-828-3837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: