Provider Demographics
NPI:1366768228
Name:FOSTER, KIMBERLY NATALIA (MS, LAC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NATALIA
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 KENNEBEC AVE
Mailing Address - Street 2:APT. 2
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5773
Mailing Address - Country:US
Mailing Address - Phone:562-277-1121
Mailing Address - Fax:
Practice Address - Street 1:5550 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4436
Practice Address - Country:US
Practice Address - Phone:562-277-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13235171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist