Healthcare Provider Details

I. General information

NPI: 1669937009
Provider Name (Legal Business Name): KATRINA SAUNDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 RUSTIN AVE
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

PO BOX 9771
MORENO VALLEY CA
92552-1771
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-7374
  • Fax:
Mailing address:
  • Phone: 323-947-3547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: