Provider Demographics
NPI:1144780487
Name:TATE, KATRINA MARIE (MD)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:TATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22401 BLUEJAY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-4837
Mailing Address - Country:US
Mailing Address - Phone:949-244-7288
Mailing Address - Fax:
Practice Address - Street 1:3800 W CHAPMAN AVE STE 6200
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1640
Practice Address - Country:US
Practice Address - Phone:714-509-2742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program