Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 5601 | CA |
NPI | 1316508096 |
---|---|
Provider Name | Katrina Rederburg |
First Address | Pacific Grove, CA 93950-5034 |
Second Address | Salinas, CA 93901-4451 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2019 |
Last Update Date | 28/06/2019 |