Healthcare Provider Details

I. General information

NPI: 1811125099
Provider Name (Legal Business Name): CATHERINE LORRAINE GAGNON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 5TH AVE STE 110
SAN DIEGO CA
92103-3122
US

IV. Provider business mailing address

6465 DEL PASO AVE
SAN DIEGO CA
92120-3137
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-1212
  • Fax:
Mailing address:
  • Phone: 507-358-4043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number18205
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number600722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: