MEDICARE: KIMBERLY DAWN PAVELICH

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
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1194473124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY DAWN PAVELICH

Provider Business Mailing Address
First Line	:	1193 E NILES AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-2229
Country	:	US
Telephone Number	:	559-269-9194
Fax Number	:

Provider Business Practice Location Address
First Line	:	1193 E NILES AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-2229
Country	:	US
Telephone Number	:	559-269-9194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2022
Last Update Date	:	03/18/2022

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Directions to “ KIMBERLY DAWN PAVELICH ” Practice Location

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