Healthcare Provider Details

I. General information

NPI: 1336923119
Provider Name (Legal Business Name): KATIE KOESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 E SANTA CLARA ST
VENTURA CA
93001-2939
US

IV. Provider business mailing address

864 E SANTA CLARA ST
VENTURA CA
93001-2939
US

V. Phone/Fax

Practice location:
  • Phone: 805-863-1646
  • Fax:
Mailing address:
  • Phone: 805-863-1646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: