Healthcare Provider Details

I. General information

NPI: 1215257696
Provider Name (Legal Business Name): CATHERINE VERONICA FOSTER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD MAILSTOP #37
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

2902 ALLRED ST
LAKEWOOD CA
90712-3306
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2077
  • Fax:
Mailing address:
  • Phone: 562-423-1931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number234624
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number16038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: