Provider Demographics
NPI:1821642513
Name:PRESCENZI, KATHERINE MIHALOV (LAC , MSTCM, DACM)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MIHALOV
Last Name:PRESCENZI
Suffix:
Gender:F
Credentials:LAC , MSTCM, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:MOSS BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:94038-0023
Mailing Address - Country:US
Mailing Address - Phone:916-606-3512
Mailing Address - Fax:
Practice Address - Street 1:890 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-2180
Practice Address - Country:US
Practice Address - Phone:916-606-3512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17267171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist