Basic Information
| Provider Information | |||||||||
| NPI: | 1295160182 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISBERTO | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 AVOCADO AVE STE 709 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926608714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4975917209 | ||||||||
| FaxNumber: | 9497591442 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 AVOCADO AVE STE 709 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497591720 | ||||||||
| FaxNumber: | 9497591442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2013 | ||||||||
| LastUpdateDate: | 09/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 23503 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 23503 | 01 | CA | CA BOARD OF REGISTERED NURSING NP FURNISHING | OTHER |