Healthcare Provider Details

I. General information

NPI: 1851091193
Provider Name (Legal Business Name): MARY-KATHARINE CHERUBINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY-KATHARINE MCMULLEN MD

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
FAIRFIELD CA
94535-1809
US

IV. Provider business mailing address

101 BODIN CIR
FAIRFIELD CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3000
  • Fax:
Mailing address:
  • Phone: 707-423-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: