Provider Demographics
NPI:1396246468
Name:SOLA-PUGHE, KATJA JOHANNA (LAC)
Entity type:Individual
Prefix:
First Name:KATJA
Middle Name:JOHANNA
Last Name:SOLA-PUGHE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2437
Mailing Address - Country:US
Mailing Address - Phone:818-212-0474
Mailing Address - Fax:
Practice Address - Street 1:7230 MEDICAL CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-4006
Practice Address - Country:US
Practice Address - Phone:213-385-0675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16835171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
823026909OtherEMPLOYER TAX ID