Provider Demographics
NPI:1548870249
Name:LOOMIS, CATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 E JACARANDA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5726
Mailing Address - Country:US
Mailing Address - Phone:617-717-8069
Mailing Address - Fax:
Practice Address - Street 1:27522 ANTONIO PKWY STE P3
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2166
Practice Address - Country:US
Practice Address - Phone:949-267-3141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA57943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant