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NPI Code Detail

MEDICARE: CHRISTINE KIMMEL PH.D.

MEDICARE: CHRISTINE KIMMEL PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist30726CA

General Provider Information

NPI Number : 1023420601
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE KIMMEL PH.D.
Provider Business Mailing Address
First Line : PO BOX 16795
Second Line :
City : SAN DIEGO
State : CA
Zip : 92176-6795
Country : US
Telephone Number : 530-760-7010
Fax Number :
Provider Business Practice Location Address
First Line : 11650 IBERIA PL STE 130
Second Line :
City : SAN DIEGO
State : CA
Zip : 92128-2431
Country : US
Telephone Number : 858-264-5858
Fax Number : 858-649-6012
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2014
Last Update Date : 10/17/2020

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Directions to “ CHRISTINE KIMMEL PH.D.” Practice Location

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