Individual
KIMBERLY ANN BRABENTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
17218 N 72ND DR STE 100, GLENDALE, AZ 85308-8581
(623) 334-8671
(623) 334-8675
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 579-3203
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2652
AZ
363A00000X
Physician Assistant
Primary
2652
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
523384
—
AZ
Enumeration date
01/30/2006
Last updated
11/19/2024
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