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General NPI Number Information
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NPI Number | 1144757733
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Entity Type | Individual
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Provider Name | KIMBERLY JACINTO D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 3500 GASTON AVE
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City | DALLAS
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State | TX
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Zip | 75246-2017
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Country | US
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Telephone | 214-820-2361
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Fax |
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Provider Business Mailing Address
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Address Line | 7401 W ARROWHEAD CLUBHOUSE DR UNIT 1088
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City | GLENDALE
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State | AZ
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Zip | 85308-8836
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Country | US
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Telephone | 530-613-1607
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | T5928
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License Number State | TX
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