Provider Demographics
NPI:1225827330
Name:SPROFERA, KIMBERLY A
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:SPROFERA
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 1:5413 TOWERS ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1222
Mailing Address - Country:US
Mailing Address - Phone:310-402-3459
Mailing Address - Fax:
Practice Address - Street 1:5413 TOWERS ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1222
Practice Address - Country:US
Practice Address - Phone:310-402-3459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-13-13797103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst