=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326284571
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. KIM RENEE SHEROW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2008
-----------------------------------------------------
Last Update Date | 12/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1660 W MISSION BLVD
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91766-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-469-4532
-----------------------------------------------------
Fax | 909-469-9563
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9150 IMPERIAL HWY
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90242-2835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-469-4532
-----------------------------------------------------
Fax | 909-469-9563
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 171M00000X
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------