Provider Demographics
NPI:1417766205
Name:DAVIDO, KIMBERLY A (CAMTC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:DAVIDO
Suffix:
Gender:F
Credentials:CAMTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15128 SHERMAN WAY APT 103
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2014
Mailing Address - Country:US
Mailing Address - Phone:323-519-1106
Mailing Address - Fax:
Practice Address - Street 1:14553 DELANO ST # 103
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2858
Practice Address - Country:US
Practice Address - Phone:818-569-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95719225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist