Individual
MRS. KIMBERLY ANN MODE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
6812 OAK AVE, SAN GABRIEL, CA 91775-2030
(909) 382-1642
Mailing address
29623 TIERRA SHORES LN, MENIFEE, CA 92584-7949
(951) 246-8118
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT2015
CA
Other
Enumeration date
04/26/2007
Last updated
07/08/2007
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