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General NPI Number Information
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NPI Number | 1245427913
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Entity Type | Individual
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Provider Name | KATYA XOCHITL HENRIQUEZ M.A.
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Gender | Female
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 1860 EL CAMINO REAL STE 406
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City | BURLINGAME
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State | CA
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Zip | 94010-3117
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Country | US
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Telephone | 650-652-0598
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Fax | 650-652-0596
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Provider Business Mailing Address
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Address Line | 1860 EL CAMINO REAL STE 406
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City | BURLINGAME
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State | CA
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Zip | 94010-3117
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Country | US
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Telephone | 650-652-0598
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Fax | 650-652-0596
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 78321
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License Number State | CA
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