Provider Demographics
NPI:1003469545
Name:SOUMOUNTHA, KATHY
Entity Type:Individual
Prefix:MISS
First Name:KATHY
Middle Name:
Last Name:SOUMOUNTHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 CABO CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7997
Mailing Address - Country:US
Mailing Address - Phone:704-488-9659
Mailing Address - Fax:
Practice Address - Street 1:427 CABO CT
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7997
Practice Address - Country:US
Practice Address - Phone:704-488-9659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility