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NPI Code Detail

MEDICARE: DR. KIMBERLY MICHELLE BAERRESEN PH.D.

MEDICARE: DR. KIMBERLY MICHELLE BAERRESEN 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
1171W00000XContractorPSY27844CA

General Provider Information

NPI Number : 1437609930
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIMBERLY MICHELLE BAERRESEN PH.D.
Provider Business Mailing Address
First Line : 602 LAKE ST
Second Line : APT 2
City : HUNTINGTON BEACH
State : CA
Zip : 92648-4764
Country : US
Telephone Number : 714-642-9519
Fax Number :
Provider Business Practice Location Address
First Line : 602 LAKE ST
Second Line : APT 2
City : HUNTINGTON BEACH
State : CA
Zip : 92648-4764
Country : US
Telephone Number : 714-642-9519
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2016
Last Update Date : 10/07/2016

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