Healthcare Provider Details

I. General information

NPI: 1326852070
Provider Name (Legal Business Name): KATARINA ROSE AZZIMONTI BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EL CAMINO REAL
ATHERTON CA
94027-4300
US

IV. Provider business mailing address

6016 BROCKENHURST DR
ELK GROVE CA
95758-6232
US

V. Phone/Fax

Practice location:
  • Phone: 650-543-3753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: