MEDICARE: KATRINA MURATALLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	VN220297	CA

General Provider Information

NPI Number	:	1619141959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA MURATALLA

Provider Business Mailing Address
First Line	:	275 BAKER ST STE A
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-4566
Country	:	US
Telephone Number	:	714-361-6760
Fax Number	:	714-361-6768

Provider Business Practice Location Address
First Line	:	275 BAKER ST STE A
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-4566
Country	:	US
Telephone Number	:	714-361-6760
Fax Number	:	714-361-6768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	03/31/2021

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