Healthcare Provider Details

I. General information

NPI: 1780270769
Provider Name (Legal Business Name): KATHERINE MIRA BUSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W LUGONIA AVE
REDLANDS CA
92374-2234
US

IV. Provider business mailing address

20 W LUGONIA AVE
REDLANDS CA
92374-2234
US

V. Phone/Fax

Practice location:
  • Phone: 909-307-5570
  • Fax:
Mailing address:
  • Phone: 909-307-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: