1215112990 NPI number — DR. KATHLEEN LINDA MUNSELL PH.D.

Table of content: RICKY WALTERS (NPI 1760785919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215112990 NPI number — DR. KATHLEEN LINDA MUNSELL PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNSELL
Provider First Name:
KATHLEEN
Provider Middle Name:
LINDA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215112990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3954
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINEDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93650-3954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-475-0210
Provider Business Mailing Address Fax Number:
599-588-4878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5240 N BOND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93710-7103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-579-7413
Provider Business Practice Location Address Fax Number:
559-588-4878
Provider Enumeration Date:
12/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY21798 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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