Basic Information
| Provider Information | |||||||||
| NPI: | 1528508173 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIJAMCO | ||||||||
| FirstName: | KATRINA | ||||||||
| MiddleName: | LUGTU | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15875 DEVONWOOD WAY | ||||||||
| Address2: | |||||||||
| City: | SAN LORENZO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945801463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103292222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7210 MURRAY DR | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952103339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093732800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2017 | ||||||||
| LastUpdateDate: | 03/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 95006275 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.