Provider Demographics
NPI:1417512450
Name:HOMER, KATHLEEN PESENTI (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:PESENTI
Last Name:HOMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 DORSETT DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7149
Mailing Address - Country:US
Mailing Address - Phone:714-964-8888
Mailing Address - Fax:714-374-6942
Practice Address - Street 1:8750 DORSETT DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-7149
Practice Address - Country:US
Practice Address - Phone:714-964-8888
Practice Address - Fax:714-374-6942
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429633163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool