Healthcare Provider Details

I. General information

NPI: 1871204289
Provider Name (Legal Business Name): KATHERINE DE LOS ANGELES TAPIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date: 04/28/2026
Reactivation Date: 05/21/2026

III. Provider practice location address

390 N EUCLID AVE
UPLAND CA
91786-6031
US

IV. Provider business mailing address

5850 GRANITE PKWY STE 600
PLANO TX
75024-6753
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-1864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: