Healthcare Provider Details

I. General information

NPI: 1174330849
Provider Name (Legal Business Name): KATERIN MICHEL DE LA O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14535 SHERMAN CIR
VAN NUYS CA
91405-3087
US

IV. Provider business mailing address

16005 VANOWEN ST APT 110
VAN NUYS CA
91406-4864
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-4830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: