Healthcare Provider Details

I. General information

NPI: 1124235874
Provider Name (Legal Business Name): KATHRYN VINSON DEITCH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WETSTONE
IRVINE CA
92604-3694
US

IV. Provider business mailing address

20 WETSTONE
IRVINE CA
92604-3694
US

V. Phone/Fax

Practice location:
  • Phone: 949-387-3904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN273156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: