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General NPI Number Information
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NPI Number | 1356807598
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Entity Type | Individual
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Provider Name | KATHRYN ARIEL KEVILLE L.AC
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Gender | Female
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Dates
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Enumeration Date | 02/12/2019
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Last Update Date | 02/12/2019
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Provider Practice Location Address
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Address Line | 315 E COTATI AVE STE E
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City | COTATI
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State | CA
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Zip | 94931-7801
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Country | US
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Telephone | 707-242-6812
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Fax |
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Provider Business Mailing Address
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Address Line | 666 W SCHOOL ST
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City | COTATI
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State | CA
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Zip | 94931-4164
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Country | US
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Telephone | 856-297-9084
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Fax |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC17507
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License Number State | CA
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