| Kimberly M Holton | |
|
10630 Town Center Dr Ste 111 Rancho Cucamonga CA 91730-6888 | |
| (909) 277-3212 | |
| Not Available |
| Full Name | Kimberly M Holton |
|---|---|
| Speciality | Social Worker |
| Location | 10630 Town Center Dr Ste 111, Rancho Cucamonga, California |
| Authorized Official Name and Position | Kimberly Holton (OWNER) |
| Authorized Official Contact | 9514655366 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kimberly M Holton 1552 Redhill North Dr Upland CA 91786-2407 Ph: () - | Kimberly M Holton 10630 Town Center Dr Ste 111 Rancho Cucamonga CA 91730-6888 Ph: (909) 277-3212 |
| NPI Number | 1306526538 |
|---|---|
| Provider Enumeration Date | 07/21/2023 |
| Last Update Date | 10/17/2023 |
| Certification Date | 10/17/2023 |
| Medicare PECOS PAC ID | 1658727292 |
|---|---|
| Medicare Enrollment ID | O20231102000520 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306526538 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kimberly M Holton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174057111 PECOS PAC ID: 2769854702 Enrollment ID: I20230221000738 |
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