Healthcare Provider Details

I. General information

NPI: 1164781969
Provider Name (Legal Business Name): MS. KATHERINE BELL ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HESPERIA RD
VICTORVILLE CA
92395-7720
US

IV. Provider business mailing address

1950 SUNWEST LANE, SUITE 200
SAN BERNARDINO CA
92415
US

V. Phone/Fax

Practice location:
  • Phone: 760-955-1777
  • Fax:
Mailing address:
  • Phone: 800-722-9886
  • Fax: 909-252-4055

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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: