Provider Demographics
NPI:1417828104
Name:KING CARDENAS, KATRINA ANN (RPRS)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:ANN
Last Name:KING CARDENAS
Suffix:
Gender:F
Credentials:RPRS
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPRS
Mailing Address - Street 1:10656 GOLDEN GATE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-4027
Mailing Address - Country:US
Mailing Address - Phone:540-272-8868
Mailing Address - Fax:
Practice Address - Street 1:10656 GOLDEN GATE AVE
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-4027
Practice Address - Country:US
Practice Address - Phone:540-272-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0735001121175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist