Healthcare Provider Details

I. General information

NPI: 1922591155
Provider Name (Legal Business Name): RAHUL YOGEE KATBAMNA MED, ATC, CES, PES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 LYNNFIELD
IRVINE CA
92620-1987
US

IV. Provider business mailing address

15 LYNNFIELD
IRVINE CA
92620-1987
US

V. Phone/Fax

Practice location:
  • Phone: 949-241-3682
  • Fax:
Mailing address:
  • Phone: 949-241-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2982
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: