Provider Demographics
NPI:1063889004
Name:JAGIELLO, KATHERINE KISMET OCHOA (MA, MS, LMFT)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:KISMET OCHOA
Last Name:JAGIELLO
Suffix:
Gender:F
Credentials:MA, MS, LMFT
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:KISMET
Other - Last Name:OCHOA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MS, LMFT
Mailing Address - Street 1:850 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5230
Mailing Address - Country:US
Mailing Address - Phone:909-421-9200
Mailing Address - Fax:
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 83162106H00000X
CA104575106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist