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General NPI Number Information
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NPI Number | 1124837794
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Entity Type | Organization
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Legal Business Name | RISING SUN MENTAL HEALTH PC
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 400 CORPORATE POINTE STE 300
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City | CULVER CITY
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State | CA
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Zip | 90230-7620
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Country | US
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Telephone | 310-351-4503
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Fax |
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Provider Business Mailing Address
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Address Line | 4742 N 24TH ST STE 300
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City | PHOENIX
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State | AZ
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Zip | 85016-9107
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Country | US
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Telephone | 623-703-9308
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHRYN LIBUSER SATYUKOV
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Credential | DNP, PMHNP
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Telephone | 310-351-4503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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