Provider Demographics
NPI:1831847441
Name:ARRIVILLAGA, KATLYN
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:ARRIVILLAGA
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 1:20220 SORRENTO LN APT 311
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4476
Mailing Address - Country:US
Mailing Address - Phone:260-385-5954
Mailing Address - Fax:
Practice Address - Street 1:20220 SORRENTO LN APT 311
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4476
Practice Address - Country:US
Practice Address - Phone:260-385-5954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-13
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28224906A163W00000X
CANP5026587363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse