Healthcare Provider Details

I. General information

NPI: 1043355894
Provider Name (Legal Business Name): KATHRYN MARIE WARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 16TH STREET
SANTA MONICA CA
90404
US

IV. Provider business mailing address

5801 VALLEY OAK DR
LOS ANGELES CA
90068-3650
US

V. Phone/Fax

Practice location:
  • Phone: 310-394-1113
  • Fax: 310-395-3218
Mailing address:
  • Phone: 323-464-5209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberOT711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: