Healthcare Provider Details

I. General information

NPI: 1699007724
Provider Name (Legal Business Name): MRS. KATHERINE KAYE CHASE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 W OCEAN AVE
LOMPOC CA
93436-6630
US

IV. Provider business mailing address

816 N O ST #92
LOMPOC CA
93436-4057
US

V. Phone/Fax

Practice location:
  • Phone: 805-736-0357
  • Fax: 805-737-0389
Mailing address:
  • Phone: 805-736-0357
  • Fax: 805-737-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: