Healthcare Provider Details

I. General information

NPI: 1558415042
Provider Name (Legal Business Name): KATHERINE ELISE FORTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 N CENTRAL AVE #103
GLENDALE CA
91203-1801
US

IV. Provider business mailing address

633 N CENTRAL AVE #103
GLENDALE CA
91203-1801
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-1174
  • Fax: 818-241-3018
Mailing address:
  • Phone: 818-241-1174
  • Fax: 818-241-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG037137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: