Healthcare Provider Details

I. General information

NPI: 1801700307
Provider Name (Legal Business Name): KATERIN BEATRIZ URETA VISTOSO SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 UNION AVE
FAIRFIELD CA
94533-3240
US

IV. Provider business mailing address

3001 N TEXAS ST APT 94
FAIRFIELD CA
94533-7323
US

V. Phone/Fax

Practice location:
  • Phone: 707-366-0685
  • Fax:
Mailing address:
  • Phone: 925-215-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: