Provider Demographics
NPI:1104065820
Name:MUNSON, KATHARINE MARIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:MARIE
Last Name:MUNSON
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 1:5 SANTA ROSA CT
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-7244
Mailing Address - Country:US
Mailing Address - Phone:310-796-1284
Mailing Address - Fax:
Practice Address - Street 1:5 SANTA ROSA CT
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-7244
Practice Address - Country:US
Practice Address - Phone:310-796-1284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11318363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical