MEDICARE: KARA KIMBALL

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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	116113	TX
3	1041C0700X	Clinical Social Worker	88023	CA

General Provider Information

NPI Number	:	1215337829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA KIMBALL

Provider Business Mailing Address
First Line	:	2635 CAMINO DEL RIO S STE 201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3728
Country	:	US
Telephone Number	:	858-256-6205
Fax Number	:

Provider Business Practice Location Address
First Line	:	2635 CAMINO DEL RIO S STE 201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3728
Country	:	US
Telephone Number	:	858-256-6205
Fax Number	:

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

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	06/12/2025

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Directions to “ KARA KIMBALL ” Practice Location

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