Provider Demographics
NPI:1245620012
Name:KIMBRELL, SENA (MACOM)
Entity type:Individual
Prefix:
First Name:SENA
Middle Name:
Last Name:KIMBRELL
Suffix:
Gender:F
Credentials:MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 N PANTANO RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3720
Mailing Address - Country:US
Mailing Address - Phone:520-722-9101
Mailing Address - Fax:
Practice Address - Street 1:2450 N PANTANO RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3720
Practice Address - Country:US
Practice Address - Phone:520-722-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0880171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist