Provider Demographics
NPI:1144639303
Name:KATY, MIKE NAJAH
Entity type:Individual
Prefix:DR
First Name:MIKE
Middle Name:NAJAH
Last Name:KATY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4184 BEYER BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-2183
Mailing Address - Country:US
Mailing Address - Phone:619-207-0406
Mailing Address - Fax:
Practice Address - Street 1:4184 BEYER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-2183
Practice Address - Country:US
Practice Address - Phone:619-207-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040401183500000X
CA80794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist