=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619644127
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIEARA MARIE CURTIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2021
-----------------------------------------------------
Last Update Date | 08/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1461 LOUDEN LN
-----------------------------------------------------
City | IMPERIAL BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91932-3244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-952-0770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2920 BRIARWOOD RD UNIT J13
-----------------------------------------------------
City | BONITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91902-1825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-857-6336
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747A0650X
-----------------------------------------------------
Taxonomy Name | Attendant Care Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------