Healthcare Provider Details

I. General information

NPI: 1619280542
Provider Name (Legal Business Name): CATHERINE C ALTRAIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHERINE EGBUZIEMALTRAIDE FNP-C

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7238 PLUM TREE PL
FONTANA CA
92336-5717
US

IV. Provider business mailing address

7238 PLUM TREE PL
FONTANA CA
92336-5717
US

V. Phone/Fax

Practice location:
  • Phone: 909-214-7327
  • Fax:
Mailing address:
  • Phone: 909-214-7327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95014006
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number573250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: