Healthcare Provider Details

I. General information

NPI: 1154887859
Provider Name (Legal Business Name): MRS. KATHERYN ELIZABETH DE ARAKAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERYN ELIZABETH SMITH

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD STE 612
PASADENA CA
91101-2015
US

IV. Provider business mailing address

710 S MYRTLE AVE # 199
MONROVIA CA
91016-3423
US

V. Phone/Fax

Practice location:
  • Phone: 626-415-7131
  • Fax:
Mailing address:
  • Phone: 626-415-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberIMF98360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: