Healthcare Provider Details

I. General information

NPI: 1962897967
Provider Name (Legal Business Name): KIMBERLY BLOOMBERG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 08/30/2020
Certification Date: 08/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ROCKMEAD DR STE 600
KINGWOOD TX
77339-2259
US

IV. Provider business mailing address

611 ROCKMEAD DR STE 600
KINGWOOD TX
77339-2259
US

V. Phone/Fax

Practice location:
  • Phone: 281-348-7575
  • Fax:
Mailing address:
  • Phone: 281-348-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR5701
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: