Provider Demographics
NPI:1033887724
Name:CAMPISANO, KATHRYN PAULA
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PAULA
Last Name:CAMPISANO
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 1:29500 HEATHERCLIFF RD SPC 145
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-6145
Mailing Address - Country:US
Mailing Address - Phone:908-247-8678
Mailing Address - Fax:
Practice Address - Street 1:314 W 4TH ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5910
Practice Address - Country:US
Practice Address - Phone:805-988-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty