Healthcare Provider Details

I. General information

NPI: 1689371924
Provider Name (Legal Business Name): KATHLEEN VARTAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN FOGARTY

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7071 WARNER AVE
HUNTINGTON BEACH CA
92647-5495
US

IV. Provider business mailing address

5134 ADENMOOR AVE
LAKEWOOD CA
90713-1806
US

V. Phone/Fax

Practice location:
  • Phone: 714-847-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number303637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: