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General NPI Number Information
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NPI Number | 1184588105
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Entity Type | Individual
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Provider Name | KIMBERLY MIZERA
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Gender | Female
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Dates
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Enumeration Date | 12/13/2025
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Last Update Date | 12/13/2025
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Provider Practice Location Address
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Address Line | 9692 OCOTILLO WAY
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City | APPLE VALLEY
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State | CA
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Zip | 92308-9714
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Country | US
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Telephone | 844-382-1040
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Fax | 833-879-4451
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Provider Business Mailing Address
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Address Line | 9692 OCOTILLO WAY
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City | APPLE VALLEY
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State | CA
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Zip | 92308-9714
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Country | US
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Telephone | 844-382-1040
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Fax | 833-879-4451
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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 | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | CPT-02042926
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License Number State |
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