Provider Demographics
NPI:1124333166
Name:HOTTMANN-WENGER, KIMBERLY K (PA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:HOTTMANN-WENGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:K
Other - Last Name:HOTTMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4836 TWAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4222
Mailing Address - Country:US
Mailing Address - Phone:760-436-4050
Mailing Address - Fax:760-436-9380
Practice Address - Street 1:324 ENCINITAS BLVD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3723
Practice Address - Country:US
Practice Address - Phone:760-436-4050
Practice Address - Fax:760-436-9380
Is Sole Proprietor?:No
Enumeration Date:2010-08-14
Last Update Date:2010-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15954363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical