MEDICARE: KATE LISETTE ALAMILLO

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	225200000X	Physical Therapy Assistant	PTA10873	CA

General Provider Information

NPI Number	:	1538754627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE LISETTE ALAMILLO

Provider Business Mailing Address
First Line	:	2595 OUTLOOK CV
Second Line	:
City	:	PORT HUENEME
State	:	CA
Zip	:	93041-1566
Country	:	US
Telephone Number	:	805-588-6766
Fax Number	:

Provider Business Practice Location Address
First Line	:	2595 OUTLOOK CV
Second Line	:
City	:	PORT HUENEME
State	:	CA
Zip	:	93041-1566
Country	:	US
Telephone Number	:	805-588-6766
Fax Number	:

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

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	03/01/2021

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Directions to “ KATE LISETTE ALAMILLO ” Practice Location

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