Healthcare Provider Details

I. General information

NPI: 1578926192
Provider Name (Legal Business Name): MISS KATELYN RAHLFS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 MORENA BLVD STE 203
SAN DIEGO CA
92110-3843
US

IV. Provider business mailing address

1202 MORENA BLVD STE 203
SAN DIEGO CA
92110-3843
US

V. Phone/Fax

Practice location:
  • Phone: 619-398-3261
  • Fax:
Mailing address:
  • Phone: 619-579-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number102895
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: