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General NPI Number Information
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NPI Number | 1538034087
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Entity Type | Individual
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Provider Name | KATHLYN DOMA
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Gender | Female
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 10780 SANTA MONICA BLVD STE 405
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City | LOS ANGELES
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State | CA
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Zip | 90025-7655
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Country | US
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Telephone | 310-234-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 4610 WESTDALE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90041-3027
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Country | US
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Telephone | 310-234-0300
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | CA
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