Kimberley Laura Ellis

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

Practice address

1196 3Rd Ave
Chula Vista, CA 91911-3131

Phone

(619) 427-4661

Fax

(619) 426-7849

NPI assigned

Feb 5, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743033600000",
    "number": "1689032559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1196 3RD AVE",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919113131",
            "telephone_number": "619-427-4661",
            "fax_number": "619-426-7849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1196 3RD AVE",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919113131",
            "telephone_number": "619-427-4661",
            "fax_number": "619-426-7849"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "835 3rd Avenue",
            "address_2": "Suite C",
            "address_purpose": "LOCATION",
            "city": "Chula Vista",
            "state": "CA",
            "postal_code": "91911",
            "country_code": "US",
            "telephone_number": "619-427-4661",
            "fax_number": "619-426-7849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KIMBERLEY",
        "middle_name": "LAURA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-05",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rehabilitation Practitioner in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Rehabilitation Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.