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General NPI Number Information
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NPI Number | 1780408955
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Entity Type | Individual
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Provider Name | KIMBERLY VICTORIA DASILVA
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Gender | Female
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 19747 GREENLEY RD
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City | SONORA
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State | CA
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Zip | 95370-5998
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Country | US
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Telephone | 209-536-3720
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Fax | 209-588-1570
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Provider Business Mailing Address
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Address Line | 1000 GREENLEY RD
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City | SONORA
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State | CA
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Zip | 95370-5200
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Country | US
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Telephone |
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86107458
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License Number State | CA
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