Basic Information
| Provider Information | |||||||||
| NPI: | 1114108578 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMAN | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Credential: | NURSE PRACTICIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91275 66TH AVE | ||||||||
| Address2: | 500 | ||||||||
| City: | MECCA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922545564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603961249 | ||||||||
| FaxNumber: | 7603961253 | ||||||||
| Practice Location | |||||||||
| Address1: | 91275 66TH STREET | ||||||||
| Address2: | 500 | ||||||||
| City: | MECCA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603961249 | ||||||||
| FaxNumber: | 7605722255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2007 | ||||||||
| LastUpdateDate: | 04/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | 6013 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
No ID Information.