Provider Demographics
NPI:1336853514
Name:MOUFARREGE, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:MOUFARREGE
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 1:2317 N PARISH PL
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-2232
Mailing Address - Country:US
Mailing Address - Phone:818-299-1972
Mailing Address - Fax:
Practice Address - Street 1:2317 N PARISH PL
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-2232
Practice Address - Country:US
Practice Address - Phone:818-299-1972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist