Provider Demographics
NPI:1043713183
Name:MAUGERI, KIMBERLEY (DC, ATC)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:MAUGERI
Suffix:
Gender:F
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 SANTA MONICA BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2438
Mailing Address - Country:US
Mailing Address - Phone:310-998-5800
Mailing Address - Fax:
Practice Address - Street 1:2915 SANTA MONICA BLVD STE 2
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2438
Practice Address - Country:US
Practice Address - Phone:310-998-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34133111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor