Provider Demographics
NPI:1811773831
Name:CABANAYAN, KATHLEEN (LAC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CABANAYAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2655
Mailing Address - Country:US
Mailing Address - Phone:408-857-4059
Mailing Address - Fax:
Practice Address - Street 1:1184 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2655
Practice Address - Country:US
Practice Address - Phone:408-857-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19794171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist