Provider Demographics
NPI:1730925009
Name:CONFORTI, KIMBERLY FRANCES
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FRANCES
Last Name:CONFORTI
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 1:690 MONTEREY AVE APT C
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-2267
Mailing Address - Country:US
Mailing Address - Phone:815-219-0612
Mailing Address - Fax:
Practice Address - Street 1:780 PINEY WAY
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1926
Practice Address - Country:US
Practice Address - Phone:805-250-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58130225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty