Active NPI
Jacquiline. Kimera
- Licensed Vocational Nurse
- Villa Park, CA
National Provider Identifier
1528870508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- 745504
- Practice address
- 1648 N Brigantine LN
Villa Park, CA 92867-4058 - Phone
- (714) 210-9502
- NPI assigned
- Jan 25, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 745504 | CA | Primary |
Addresses
Primary practice location
1648 N Brigantine LN
Villa Park, CA 92867-4058
Mailing address
1648 N Brigantine LN
Villa Park, CA 92867-4058
Phone (714) 210-9502
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 745504 | CA | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1737763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776470400000",
"number": "1528870508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1648 N BRIGANTINE LN",
"city": "VILLA PARK",
"state": "CA",
"postal_code": "928674058",
"telephone_number": "714-210-9502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1648 N BRIGANTINE LN",
"city": "VILLA PARK",
"state": "CA",
"postal_code": "928674058",
"telephone_number": "714-210-9502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMERA",
"first_name": "JACQUILINE.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-01-25",
"last_updated": "2026-04-18",
"certification_date": "2026-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "CA",
"license": "745504",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Villa Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.