Healthcare Provider Details

I. General information

NPI: 1114638053
Provider Name (Legal Business Name): KATIE BESANKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1762 WESTWOOD BLVD STE 320
LOS ANGELES CA
90024-5641
US

IV. Provider business mailing address

1762 WESTWOOD BLVD STE 320
LOS ANGELES CA
90024-5641
US

V. Phone/Fax

Practice location:
  • Phone: 413-455-8555
  • Fax:
Mailing address:
  • Phone: 413-455-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number66807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: