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General NPI Number Information
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NPI Number | 1144375791
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Entity Type | Individual
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Provider Name | KATHERINE A TEEPLE A84177
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1031 AVENIDA PICO STE 106
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6355
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Country | US
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Telephone | 949-373-1133
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Fax | 949-373-1135
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Provider Business Mailing Address
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Address Line | 315 W AVE DE LOS MARINOS
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City | SAN CLEMENTE
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State | CA
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Zip | 92672
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Country | US
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Telephone | 949-373-1133
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Fax | 949-373-1135
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | A84177
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License Number State | CA
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