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General NPI Number Information
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NPI Number | 1457470148
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Entity Type | Individual
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Provider Name | SUSANA WAYETA KATAKA N.P.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 2401 E ORANGEBURG AVE STE 330
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City | MODESTO
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State | CA
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Zip | 95355-3396
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Country | US
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Telephone | 209-383-5871
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Fax |
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Provider Business Mailing Address
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Address Line | 12645 MEMORIAL DR STE 1
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City | HOUSTON
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State | TX
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Zip | 77024-4898
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Country | US
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Telephone | 713-291-4084
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 680495
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 680495
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | AP113842
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 11938
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 95028644
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License Number State | CA
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