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General NPI Number Information
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NPI Number | 1417828872
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Entity Type | Individual
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Provider Name | KATHERINE ELIZABETH TRAVIS DMD
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Gender | Female
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 12/24/2025
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Provider Practice Location Address
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Address Line | 714 TIVERTON DR
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City | LOS ANGELES
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State | CA
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Zip | 90095-8361
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Country | US
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Telephone | 310-825-6510
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Fax |
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Provider Business Mailing Address
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Address Line | 1665 9TH AVE APT 5
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City | SAN DIEGO
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State | CA
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Zip | 92101-2847
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Country | US
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Telephone | 424-235-4746
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS112291
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License Number State | CA
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