Healthcare Provider Details

I. General information

NPI: 1962323931
Provider Name (Legal Business Name): KATHERINE RENE DERFLINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 MORENA BLVD STE 100
SAN DIEGO CA
92110-3850
US

IV. Provider business mailing address

1260 MORENA BLVD STE 100
SAN DIEGO CA
92110-3850
US

V. Phone/Fax

Practice location:
  • Phone: 619-398-0355
  • Fax: 619-398-0350
Mailing address:
  • Phone: 619-398-0355
  • Fax: 619-398-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: