Healthcare Provider Details

I. General information

NPI: 1104115880
Provider Name (Legal Business Name): KATHERINE TAYAG BELEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3142 G ST
MERCED CA
95340-1368
US

IV. Provider business mailing address

3044 G ST APT 28
MERCED CA
95340-2124
US

V. Phone/Fax

Practice location:
  • Phone: 209-383-9086
  • Fax:
Mailing address:
  • Phone: 408-886-0095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 65009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: