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General NPI Number Information
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NPI Number | 1932628443
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Entity Type | Individual
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Provider Name | KIMBERLY CHARLOTTE DE LA VEGA MA
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Gender | Female
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Dates
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Enumeration Date | 09/15/2017
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 10053 WHITTWOOD DR PO BOX 1176 STE A
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City | WHITTIER
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State | CA
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Zip | 90609
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Country | US
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Telephone | 714-987-2274
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Fax |
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Provider Business Mailing Address
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Address Line | 10053 WHITTWOOD DR PO BOX 1176 STE A
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City | WHITTIER
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State | CA
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Zip | 90609
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Country | US
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Telephone | 714-987-2274
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 100730
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License Number State | CA
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