Provider Demographics
NPI:1154735157
Name:FATINO, CATHERINE ANNE (RDHAP)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:ANNE
Last Name:FATINO
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ANNE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RXH
Mailing Address - Street 1:PO BOX 9484
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96158-2484
Mailing Address - Country:US
Mailing Address - Phone:541-640-1644
Mailing Address - Fax:
Practice Address - Street 1:1088 4TH ST # 7
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-3460
Practice Address - Country:US
Practice Address - Phone:541-640-1644
Practice Address - Fax:530-600-2679
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24278124Q00000X
CA511124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist