Individual
KIMBERLY RAE FAIRGRIEF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2914 COLD SPRINGS RD, SUITE A, PLACERVILLE, CA 95667-4220
(530) 642-1715
Mailing address
2914 COLD SPRINGS RD, SUITE A, PLACERVILLE, CA 95667-4220
(530) 642-1715
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4715
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4715
CAS
CA
Enumeration date
10/30/2007
Last updated
10/30/2007
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