Provider Demographics
NPI:1467584136
Name:GASCA-DIXON, KATHLEEN JEAN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JEAN
Last Name:GASCA-DIXON
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 1:13313 OXNARD ST
Mailing Address - Street 2:#205
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-4012
Mailing Address - Country:US
Mailing Address - Phone:818-939-7504
Mailing Address - Fax:
Practice Address - Street 1:14550 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2210
Practice Address - Country:US
Practice Address - Phone:818-901-4879
Practice Address - Fax:818-997-1370
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner