Provider Demographics
NPI:1053597062
Name:KATHRYN FALLON & ASSOCIATES
Entity type:Organization
Organization Name:KATHRYN FALLON & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM.
Authorized Official - Prefix:MRS
Authorized Official - First Name:SELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEZA HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-346-2500
Mailing Address - Street 1:6700 FALLBROOK AVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3530
Mailing Address - Country:US
Mailing Address - Phone:818-346-2500
Mailing Address - Fax:818-346-2514
Practice Address - Street 1:6700 FALLBROOK AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-3530
Practice Address - Country:US
Practice Address - Phone:818-346-2500
Practice Address - Fax:818-346-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWYO74OtherMEDICARE PROVIDER