MEDICARE: KATHERINE FRANCES MIGLIACCIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	138123	CA

General Provider Information

NPI Number	:	1255104378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE FRANCES MIGLIACCIO

Provider Business Mailing Address
First Line	:	23985 LEMON AVE
Second Line	:
City	:	PERRIS
State	:	CA
Zip	:	92570-8193
Country	:	US
Telephone Number	:	951-581-2707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1881 COMMERCENTER E STE 232
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3479
Country	:	US
Telephone Number	:	909-890-4466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	10/31/2023

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