Basic Information
| Provider Information | |||||||||
| NPI: | 1699007724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHASE | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | KAYE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 816 N O ST | ||||||||
| Address2: | #92 | ||||||||
| City: | LOMPOC | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934364057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057360357 | ||||||||
| FaxNumber: | 8057370389 | ||||||||
| Practice Location | |||||||||
| Address1: | 604 W OCEAN AVE | ||||||||
| Address2: | |||||||||
| City: | LOMPOC | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934366630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057360357 | ||||||||
| FaxNumber: | 8057370389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2010 | ||||||||
| LastUpdateDate: | 01/29/2010 | ||||||||
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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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.