Provider Demographics
NPI:1255104378
Name:MIGLIACCIO, KATHERINE FRANCES
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:FRANCES
Last Name:MIGLIACCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23985 LEMON AVE
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-8193
Mailing Address - Country:US
Mailing Address - Phone:951-581-2707
Mailing Address - Fax:
Practice Address - Street 1:1881 COMMERCENTER E STE 232
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3479
Practice Address - Country:US
Practice Address - Phone:909-890-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138123106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist