Provider Demographics
NPI:1174135321
Name:SATYUKOV, KATHRYN LIBUSER (PMHNP, DNP)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LIBUSER
Last Name:SATYUKOV
Suffix:
Gender:F
Credentials:PMHNP, DNP
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:LIBUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN
Mailing Address - Street 1:400 CORPORATE POINTE STE 300
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7620
Mailing Address - Country:US
Mailing Address - Phone:602-767-2456
Mailing Address - Fax:
Practice Address - Street 1:400 CORPORATE POINTE STE 300
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-7620
Practice Address - Country:US
Practice Address - Phone:602-767-2456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2024-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA833635163W00000X
CA95029499363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse