Provider Demographics
NPI:1508030388
Name:VYVYAN, CATALINA GEISENDORF (IMF)
Entity Type:Individual
Prefix:MRS
First Name:CATALINA
Middle Name:GEISENDORF
Last Name:VYVYAN
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 STEELE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4619
Mailing Address - Country:US
Mailing Address - Phone:619-590-1879
Mailing Address - Fax:
Practice Address - Street 1:2815 STEELE CANYON RD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-4619
Practice Address - Country:US
Practice Address - Phone:619-590-1879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist