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NPI Code Detail

MEDICARE: KIMBERLY RUNDSTROM PH.D.

MEDICARE: KIMBERLY RUNDSTROM 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
1103TS0200XSchool PsychologistCA

General Provider Information

NPI Number : 1497606263
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY RUNDSTROM PH.D.
Provider Business Mailing Address
First Line : 1500 LIZZIE ST STE G-1
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-3062
Country : US
Telephone Number : 805-596-4055
Fax Number :
Provider Business Practice Location Address
First Line : 1500 LIZZIE ST STE G-1
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-3062
Country : US
Telephone Number : 805-596-4055
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2026
Last Update Date : 02/06/2026

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Directions to “ KIMBERLY RUNDSTROM PH.D.” Practice Location

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