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General NPI Number Information
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NPI Number | 1114108578
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Entity Type | Individual
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Provider Name | KATHERINE ROMAN NURSE PRACTICIONER
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Gender | Female
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 04/03/2014
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Provider Practice Location Address
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Address Line | 91275 66TH STREET 500
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City | MECCA
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State | CA
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Zip | 92254
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Country | US
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Telephone | 760-396-1249
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Fax | 760-572-2255
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Provider Business Mailing Address
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Address Line | 91275 66TH AVE 500
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City | MECCA
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State | CA
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Zip | 92254-5564
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Country | US
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Telephone | 760-396-1249
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Fax | 760-396-1253
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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 | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 6013
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License Number State | CA
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