Provider Demographics
NPI:1144554668
Name:LEE-THORP, KIMBERLEY ANNE
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ANNE
Last Name:LEE-THORP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CALLE CONCHITA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-5404
Mailing Address - Country:US
Mailing Address - Phone:949-547-0716
Mailing Address - Fax:
Practice Address - Street 1:111 AVENIDA DEL MAR STE 215
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4001
Practice Address - Country:US
Practice Address - Phone:949-547-0716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 374J00000X
570332-09 (NAT'L)225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula