Provider Demographics
NPI:1417226648
Name:KATTASH MEDICAL CORPORATION
Entity type:Organization
Organization Name:KATTASH MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARRIAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-987-9100
Mailing Address - Street 1:8710 MONROE CT
Mailing Address - Street 2:SUITE 250
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4883
Mailing Address - Country:US
Mailing Address - Phone:909-987-9100
Mailing Address - Fax:909-987-9113
Practice Address - Street 1:8710 MONROE CT
Practice Address - Street 2:SUITE 250
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4883
Practice Address - Country:US
Practice Address - Phone:909-987-9100
Practice Address - Fax:909-987-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88104261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center