Provider Demographics
NPI:1932422367
Name:MUSHAMEL, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:MUSHAMEL
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 1:2100 DR MARTIN LUTHER KING JUNIOR PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4422
Mailing Address - Country:US
Mailing Address - Phone:530-893-0288
Mailing Address - Fax:
Practice Address - Street 1:2100 DR MARTIN LUTHER KING JUNIOR PKWY
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-4422
Practice Address - Country:US
Practice Address - Phone:530-893-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-13
Last Update Date:2010-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13757152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist