Healthcare Provider Details

I. General information

NPI: 1881646370
Provider Name (Legal Business Name): CATHERINE ANTONIE KAUFMAN IDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL CAMP PENDLETON DIRECTORATE OF SURGICAL SERVICES
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

1826 THIBODO ROAD #104
VISTA CA
92081-7585
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1087
  • Fax:
Mailing address:
  • Phone: 760-842-7626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: