Provider Demographics
NPI:1619794229
Name:RESENDIZ, KATELYNN CHRISTINE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KATELYNN
Middle Name:CHRISTINE
Last Name:RESENDIZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATELYNN
Other - Middle Name:CHRISTINE
Other - Last Name:WEGRZYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6674 LEANNE ST
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-3478
Mailing Address - Country:US
Mailing Address - Phone:951-255-3697
Mailing Address - Fax:
Practice Address - Street 1:1800 WESTERN AVE STE 204
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1353
Practice Address - Country:US
Practice Address - Phone:909-474-9952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant