Healthcare Provider Details

I. General information

NPI: 1285977587
Provider Name (Legal Business Name): KATHERINE R. NEWCOMB M.D. MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18661 MAIN ST
GROVELAND CA
95321-9432
US

IV. Provider business mailing address

21340 BEAVER CT
GROVELAND CA
95321-9504
US

V. Phone/Fax

Practice location:
  • Phone: 209-962-7121
  • Fax: 209-962-0665
Mailing address:
  • Phone: 209-770-5283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG59102
License Number StateCA

VIII. Authorized Official

Name: KATHERINE RENEE NEWCOMB
Title or Position: CEO
Credential: M.D.
Phone: 209-770-5283