MEDICARE: CATHERINE LORRAINE GAGNON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	18205	CA
2	207QA0505X	Adult Medicine Physician	600722	CA

General Provider Information

NPI Number	:	1811125099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE LORRAINE GAGNON NP

Provider Business Mailing Address
First Line	:	6465 DEL PASO AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-3137
Country	:	US
Telephone Number	:	507-358-4043
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 5TH AVE STE 110
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3122
Country	:	US
Telephone Number	:	858-554-1212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2009
Last Update Date	:	09/17/2025

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