Provider Demographics
NPI:1689422610
Name:FIELDS, KIMBERLY K (CNA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:FIELDS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23232 PERALTA DR STE 107
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1436
Mailing Address - Country:US
Mailing Address - Phone:949-878-6127
Mailing Address - Fax:
Practice Address - Street 1:23232 PERALTA DR STE 107
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1436
Practice Address - Country:US
Practice Address - Phone:949-878-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01291174376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty