Provider Demographics
NPI:1346344702
Name:MINESINGER, KIMBERLY ELLEN (DO)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ELLEN
Last Name:MINESINGER
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1901 TOWN AND COUNTRY DR
Mailing Address - Street 2:STE. 104
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1820 FULLERTON AVE STE 115
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3160
Practice Address - Country:US
Practice Address - Phone:951-817-5000
Practice Address - Fax:951-817-5002
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7484207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH18840Medicare UPIN