Provider Demographics
NPI:1063053544
Name:KATEMBO, BEATRICE KUVUNA (COTA)
Entity type:Individual
Prefix:
First Name:BEATRICE
Middle Name:KUVUNA
Last Name:KATEMBO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15652 WILLIAMS ST APT 14J
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4831
Mailing Address - Country:US
Mailing Address - Phone:415-324-9331
Mailing Address - Fax:
Practice Address - Street 1:9025 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-2157
Practice Address - Country:US
Practice Address - Phone:951-688-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4932224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant