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General NPI Number Information
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NPI Number | 1073259479
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Entity Type | Individual
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Provider Name | KATIE LYNN RICHARDSON PA
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Gender | Female
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 21250 HAWTHORNE BLVD STE 430
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City | TORRANCE
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State | CA
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Zip | 90503-5511
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Country | US
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Telephone | 310-326-3066
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Fax | 310-326-3068
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Provider Business Mailing Address
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Address Line | 15507 S NORMANDIE AVE # 231
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City | GARDENA
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State | CA
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Zip | 90247-4028
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Country | US
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Telephone | 714-292-7359
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60727
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA60727
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License Number State | CA
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