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General NPI Number Information
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NPI Number | 1639443104
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Entity Type | Individual
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Provider Name | KATHARINE CHRISTINA LONG M.D
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Gender | Female
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Dates
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Enumeration Date | 03/01/2012
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Last Update Date | 07/12/2016
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Provider Practice Location Address
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Address Line | 9300 VALLEY CHILDRENS PL VALLEY CHILDREN'S HOSPITAL
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City | MADERA
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State | CA
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Zip | 93636-8761
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Country | US
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Telephone | 717-586-0629
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Fax |
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Provider Business Mailing Address
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Address Line | 1830 N SANDERS AVE
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City | CLOVIS
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State | CA
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Zip | 93619-2010
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Country | US
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Telephone | 717-586-0629
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A119576
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | MD452181
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License Number State | PA
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