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General NPI Number Information
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NPI Number | 1962799825
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Entity Type | Individual
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Provider Name | MAXINE LORRAINE KIBBLE
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Gender | Female
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 06/29/2011
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Provider Practice Location Address
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Address Line | 292 EUCLID AVE SUITE #112
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City | SAN DIEGO
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State | CA
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Zip | 92114-3643
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Country | US
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Telephone | 619-662-4100
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Fax | 619-428-7952
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Provider Business Mailing Address
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Address Line | 4004 BEYER BLVD
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City | SAN YSIDRO
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State | CA
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Zip | 92173-2007
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Country | US
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Telephone | 619-662-4100
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Fax | 619-428-7952
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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 |
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License Number State |
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