Healthcare Provider Details

I. General information

NPI: 1275011074
Provider Name (Legal Business Name): KATHLEEN THERESA GATHINGS RRT, RPFT, CCT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE
FONTANA CA
92335
US

IV. Provider business mailing address

9961 SIERRA AVE
FONTANA CA
92335-6720
US

V. Phone/Fax

Practice location:
  • Phone: 909-427-5270
  • Fax: 909-427-4434
Mailing address:
  • Phone: 909-427-5270
  • Fax: 909-427-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225B00000X
TaxonomyPulmonary Function Technologist
License Number15677
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number00024861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: