Healthcare Provider Details

I. General information

NPI: 1215288048
Provider Name (Legal Business Name): CATAREYA LIEP MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 N CAMPUS AVE
ONTARIO CA
91764-4229
US

IV. Provider business mailing address

437 N CAMPUS AVE
ONTARIO CA
91764-4229
US

V. Phone/Fax

Practice location:
  • Phone: 909-988-8203
  • Fax: 909-988-5006
Mailing address:
  • Phone: 909-988-8203
  • Fax: 909-988-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CATAREYA P LIEP
Title or Position: PRESIDENT
Credential: MD
Phone: 909-988-8203