Basic Information
| Provider Information | |||||||||
| NPI: | 1316456734 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KIMBERLY ROSE DAVIS MD INC APMC | ||||||||
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| OtherOrganizationName: | KIMBERLY ROSE DAVIS, MD INC A PROFESSIONAL MEDICAL CORPORATION | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 153 SOUTH SIERRA # 1167 | ||||||||
| Address2: | |||||||||
| City: | SOLANA BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920752050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584619866 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2181 CITRACADO PARKWY | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920294159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4422776100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2017 | ||||||||
| LastUpdateDate: | 09/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8584619866 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | A142106 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
ID Information
| ID | Type | State | Issuer | Description | A142106 | 01 | CA | MEDICAL LICENSE | OTHER |