Provider Demographics
NPI:1538757661
Name:KNOPF, KIMBERLY VAIO
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:VAIO
Last Name:KNOPF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MARIA
Other - Last Name:VAIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23050 EVANGELINE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7031
Mailing Address - Country:US
Mailing Address - Phone:210-334-5890
Mailing Address - Fax:
Practice Address - Street 1:23050 EVANGELINE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7031
Practice Address - Country:US
Practice Address - Phone:210-334-5890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84905101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional