Provider Demographics
NPI:1295517464
Name:MILLO-BAYAN, KATLENE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KATLENE
Middle Name:
Last Name:MILLO-BAYAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:KATLENE
Other - Middle Name:
Other - Last Name:MILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39951 FREMONT BLVD APT 324
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2685
Mailing Address - Country:US
Mailing Address - Phone:408-609-4948
Mailing Address - Fax:
Practice Address - Street 1:39180 LIBERTY ST STE 205
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2586
Practice Address - Country:US
Practice Address - Phone:510-451-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2023088391363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health