MEDICARE: KIMBERLY CLAUDAT I 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
1	103T00000X	Psychologist	PSY28581	CA

General Provider Information

NPI Number	:	1699200949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY CLAUDAT I PH.D.

Provider Business Mailing Address
First Line	:	4510 EXECUTIVE DR
Second Line	:	SUITE 315
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3021
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4370 LA JOLLA VILLAGE DR
Second Line	:	SUITE 400
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1249
Country	:	US
Telephone Number	:	858-342-4466
Fax Number	:

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

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	04/25/2017

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