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General NPI Number Information
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NPI Number | 1407644669
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Entity Type | Individual
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Provider Name | KIMBERLY SANTOS-AVILES PHD
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Gender | Female
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 220 E ROGERS RD
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City | LONGMONT
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State | CO
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Zip | 80501-6027
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Country | US
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Telephone | 303-697-2583
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Fax |
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Provider Business Mailing Address
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Address Line | 3850 RONAN LOOP UNIT 101
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City | CASTLE ROCK
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State | CO
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Zip | 80108-8913
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Country | US
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Telephone | 720-713-0150
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY.0006731
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License Number State | CO
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