Healthcare Provider Details

I. General information

NPI: 1093295107
Provider Name (Legal Business Name): KIMBERLY G LLAMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 AIRLINE RD
CORPUS CHRISTI TX
78414-3306
US

IV. Provider business mailing address

4618 WALES DR
CORPUS CHRISTI TX
78413-4341
US

V. Phone/Fax

Practice location:
  • Phone: 361-992-0816
  • Fax:
Mailing address:
  • Phone: 361-563-8487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number210039
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: