Kimberly Dennise Madorsky, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA19989 Issued in CA

Practice address

17577 Arrow Blvd
Fontana, CA 92335-4011

Phone

(909) 823-4454

Fax

(909) 823-6918

NPI assigned

Nov 26, 2008

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

Other names 1

• Kimberly Dennise Haines Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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

{
    "created_epoch": "1227657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549324800000",
    "number": "1912152380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 W REDLANDS BLVD",
            "address_2": "SECOND FLOOR",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923733145",
            "telephone_number": "909-890-0407",
            "fax_number": "909-890-4597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17577 ARROW BLVD",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923354011",
            "telephone_number": "909-823-4454",
            "fax_number": "909-823-6918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADORSKY",
        "first_name": "KIMBERLY",
        "middle_name": "DENNISE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-26",
        "last_updated": "2019-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA19989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "HAINES",
            "middle_name": "DENNISE",
            "credential": "NONE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Heather J Maddox, RN, CRNA
• Nancy Madi
• Erica Firman Madiedo, M.A., CCC-A
• Kyleigh Madill
• Lisa A Madison, AUD
• Jennifer Madrid
• Julio Madrid, RDA
• Ivan V. Madzarevic, D.D.S.
• Sylvia Dolores Magallanes, CNM, RNP, MS
• Cecilia R Magana

• Physician Assistant in Fontana, CA
• Providers in Fontana, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.