MEDICARE: DR. KIMBERLY JUNE LIGHT-ALLENDE PSY.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
1	103TC0700X	Clinical Psychologist	PSY 20476	CA

General Provider Information

NPI Number	:	1497872915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY JUNE LIGHT-ALLENDE PSY.D.

Provider Business Mailing Address
First Line	:	15218 SUMMIT AVENUE #300-313
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-0232
Country	:	US
Telephone Number	:	909-425-7487
Fax Number	:	909-463-7410

Provider Business Practice Location Address
First Line	:	15218 SUMMIT AVE # 300-313
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-0232
Country	:	US
Telephone Number	:	909-425-7487
Fax Number	:	909-463-7410

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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