Provider Demographics
NPI:1275164030
Name:MACAPINLAC, KATHERINE MANANSALA
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MANANSALA
Last Name:MACAPINLAC
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 1:10961 SAN BLAS CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2447
Mailing Address - Country:US
Mailing Address - Phone:858-231-1321
Mailing Address - Fax:
Practice Address - Street 1:10961 SAN BLAS CIR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2447
Practice Address - Country:US
Practice Address - Phone:858-231-1321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17698225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist