Healthcare Provider Details

I. General information

NPI: 1972752095
Provider Name (Legal Business Name): CATHERINE THEO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 FILLMORE ST
SAN FRANCISCO CA
94123-4009
US

IV. Provider business mailing address

2081 ARENA BLVD SUITE: 160
SACRAMENTO CA
95834-2309
US

V. Phone/Fax

Practice location:
  • Phone: 415-292-3440
  • Fax: 415-561-0244
Mailing address:
  • Phone: 916-576-7898
  • Fax: 916-285-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA107063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: