Provider Demographics
NPI:1588245104
Name:BAESEL, KIMBERLY JONES
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JONES
Last Name:BAESEL
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 1:6700 INDIANA AVE STE 252
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4264
Mailing Address - Country:US
Mailing Address - Phone:951-530-8257
Mailing Address - Fax:760-818-8025
Practice Address - Street 1:6700 INDIANA AVE STE 252
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4264
Practice Address - Country:US
Practice Address - Phone:951-530-8257
Practice Address - Fax:760-818-8025
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist