Healthcare Provider Details

I. General information

NPI: 1437193174
Provider Name (Legal Business Name): KATHY LOUISE PRINCIPI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROHNERT PARK MEDICAL CENTER 1450 MEDICAL CENTER DRIVE
ROHNERT PARK CA
94928
US

IV. Provider business mailing address

1877 TOYON DR
HEALDSBURG CA
95448-9431
US

V. Phone/Fax

Practice location:
  • Phone: 707-584-0672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG85682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: