Provider Demographics
NPI:1871836031
Name:MONICA, KIMBERLY (HIS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MONICA
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23838 VALENCIA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5319
Mailing Address - Country:US
Mailing Address - Phone:661-284-1900
Mailing Address - Fax:
Practice Address - Street 1:23838 VALENCIA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5319
Practice Address - Country:US
Practice Address - Phone:661-284-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7714237600000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter