Healthcare Provider Details

I. General information

NPI: 1154230472
Provider Name (Legal Business Name): KATHERINE MICHELLE LUDVIK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY LUDVIK RN

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST
SAN FRANCISCO CA
94121-1563
US

IV. Provider business mailing address

28 CORLISS DR
MORAGA CA
94556-1205
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax:
Mailing address:
  • Phone: 415-221-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number714962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: