Healthcare Provider Details

I. General information

NPI: 1962674044
Provider Name (Legal Business Name): KATRINA D LOFTIS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 MACKAY DR
SAN BERNARDINO CA
92408-3222
US

IV. Provider business mailing address

490 W 14TH ST
LONG BEACH CA
90813-2943
US

V. Phone/Fax

Practice location:
  • Phone: 909-433-9300
  • Fax:
Mailing address:
  • Phone: 562-591-8701
  • Fax: 562-591-6841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN 170258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: