Healthcare Provider Details

I. General information

NPI: 1821642513
Provider Name (Legal Business Name): KATHERINE MIHALOV PRESCENZI L.AC. , MSTCM, DACM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 MAIN ST STE C
HALF MOON BAY CA
94019-2180
US

IV. Provider business mailing address

PO BOX 23
MOSS BEACH CA
94038-0023
US

V. Phone/Fax

Practice location:
  • Phone: 916-606-3512
  • Fax:
Mailing address:
  • Phone: 916-606-3512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: