MEDICARE: KIMBERLY GATES

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	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16159	OTHER	CA	LICENSE#

General Provider Information

NPI Number	:	1376621292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY GATES

Provider Business Mailing Address
First Line	:	4458 PARKS AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-6175
Country	:	US
Telephone Number	:	760-519-6670
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 OCEANSIDE BLVD STE A-C
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-5821
Country	:	US
Telephone Number	:	760-940-6118
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/08/2019

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Directions to “ KIMBERLY GATES ” Practice Location

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