Provider Demographics
NPI:1144375791
Name:TEEPLE, KATHERINE A (A84177)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:A
Last Name:TEEPLE
Suffix:
Gender:F
Credentials:A84177
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:315 W AVE
Mailing Address - Street 2:DE LOS MARINOS
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672
Mailing Address - Country:US
Mailing Address - Phone:949-373-1133
Mailing Address - Fax:949-373-1135
Practice Address - Street 1:1031 AVENIDA PICO STE 106
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6355
Practice Address - Country:US
Practice Address - Phone:949-373-1133
Practice Address - Fax:949-373-1135
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA841772080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine