Healthcare Provider Details

I. General information

NPI: 1588438055
Provider Name (Legal Business Name): KATY ROSE CFMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4644 ESTRELLA AVE
SAN DIEGO CA
92115-3221
US

IV. Provider business mailing address

4644 ESTRELLA AVE
SAN DIEGO CA
92115-3221
US

V. Phone/Fax

Practice location:
  • Phone: 619-895-7322
  • Fax:
Mailing address:
  • Phone: 619-895-7322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: