Active NPI
Kimberly Ganivet
- Mental Health Counselor
- Rancho Cucamonga, CA
National Provider Identifier
1760279558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 148310
- Practice address
- 9065 Haven Ave Ste 110
Rancho Cucamonga, CA 91730-5429 - Phone
- (909) 757-5770
- NPI assigned
- Apr 23, 2025
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 148310 | CA | Primary |
Addresses
Primary practice location
9065 Haven Ave Ste 110
Rancho Cucamonga, CA 91730-5429
Mailing address
325 S San Dimas Canyon Rd Apt 66
San Dimas, CA 91773-3057
Phone (626) 863-0351
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 |
|---|---|---|---|
| 148310 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1745366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745366400000",
"number": "1760279558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 S SAN DIMAS CANYON RD APT 66",
"city": "SAN DIMAS",
"state": "CA",
"postal_code": "917733057",
"telephone_number": "626-863-0351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9065 HAVEN AVE STE 110",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917305429",
"telephone_number": "909-757-5770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANIVET",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-04-23",
"last_updated": "2025-04-23",
"certification_date": "2025-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "148310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 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.