Individual
KIMBERLY DAUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14541 DELANO ST, VAN NUYS, CA 91411-2820
(877) 515-8113
Mailing address
4478 9TH ST, RIVERSIDE, CA 92501-3108
(951) 877-0141
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95026843
CA
Other
Enumeration date
08/28/2023
Last updated
10/24/2023
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