Provider Demographics
NPI:1750621934
Name:FRIED, KIMBERLY SHER (LAC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:SHER
Last Name:FRIED
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 JEFFERSON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1717
Mailing Address - Country:US
Mailing Address - Phone:619-840-3091
Mailing Address - Fax:
Practice Address - Street 1:2815 JEFFERSON ST STE 202
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008
Practice Address - Country:US
Practice Address - Phone:619-840-3091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12477171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist