Healthcare Provider Details

I. General information

NPI: 1124470364
Provider Name (Legal Business Name): KATIE CATHCART LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 W VALLEY PKWY STE 102
ESCONDIDO CA
92025-2549
US

IV. Provider business mailing address

613 W VALLEY PKWY STE 102
ESCONDIDO CA
92025-2549
US

V. Phone/Fax

Practice location:
  • Phone: 858-385-9399
  • Fax: 760-294-9603
Mailing address:
  • Phone: 858-385-9399
  • Fax: 760-294-9603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number282582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: