Individual
KIMBERLY LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTIONER
Contact information
Practice address
8851 CENTER DR, SUITE 501, LA MESA, CA 91942-3017
(619) 697-2456
(619) 697-2494
Mailing address
8851 CENTER DR, SUITE 501, LA MESA, CA 91942-3017
(619) 697-2456
(619) 697-2494
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
337173
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
337173
LICENSE NUMBER
CA
Enumeration date
05/20/2010
Last updated
05/20/2010
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