Provider Demographics
NPI:1194531988
Name:FAUSITNO-KUGLEN, NATHALIE RAMATOU
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:RAMATOU
Last Name:FAUSITNO-KUGLEN
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 1:1339 33RD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2410
Mailing Address - Country:US
Mailing Address - Phone:619-252-6212
Mailing Address - Fax:
Practice Address - Street 1:6949 GENESEE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-2455
Practice Address - Country:US
Practice Address - Phone:619-605-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW122244104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker