Healthcare Provider Details

I. General information

NPI: 1679816938
Provider Name (Legal Business Name): JULIA REGINA KATSUURA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA REGIA POLLOCK MD

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 HOSPITAL DR STE 204
UKIAH CA
95482-4568
US

IV. Provider business mailing address

260 HOSPITAL DR STE 204
UKIAH CA
95482-4568
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-7459
  • Fax:
Mailing address:
  • Phone: 707-463-7459
  • Fax: 423-778-6925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54442
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number170569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: