Provider Demographics
NPI:1285878199
Name:SPEARS, KIMBERLY RENEE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RENEE
Last Name:SPEARS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 ACKERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4958
Mailing Address - Country:US
Mailing Address - Phone:310-603-7343
Mailing Address - Fax:
Practice Address - Street 1:5560 ACKERFIELD AVE.
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4958
Practice Address - Country:US
Practice Address - Phone:310-603-7343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator