1548407158 NPI number — MRS. KATHLEEN REGINA REAZER MS, MFT

Table of content: MRS. KATHLEEN REGINA REAZER MS, MFT (NPI 1548407158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548407158 NPI number — MRS. KATHLEEN REGINA REAZER MS, MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REAZER
Provider First Name:
KATHLEEN
Provider Middle Name:
REGINA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, MFT
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:
1548407158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 SCIENCE DRIVE
Provider Second Line Business Mailing Address:
#235
Provider Business Mailing Address City Name:
MOORPARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93021-2094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-217-1224
Provider Business Mailing Address Fax Number:
805-529-1004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 SCIENCE DR
Provider Second Line Business Practice Location Address:
#235
Provider Business Practice Location Address City Name:
MOORPARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93021-2094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-217-1224
Provider Business Practice Location Address Fax Number:
805-529-1004
Provider Enumeration Date:
01/20/2009

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: 106H00000X , with the licence number:  MFC43176 , 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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