Healthcare Provider Details

I. General information

NPI: 1609450774
Provider Name (Legal Business Name): KATHERINE ANGELA NORIEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24330 EL TORO RD
LAGUNA WOODS CA
92637-2775
US

IV. Provider business mailing address

1205 S ARAPAHO DR
SANTA ANA CA
92704-2408
US

V. Phone/Fax

Practice location:
  • Phone: 949-830-0391
  • Fax:
Mailing address:
  • Phone: 714-292-0345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH129194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: