Provider Demographics
NPI:1487748943
Name:GROVES-REHWALDT, KATRINA CAROL (MD)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:CAROL
Last Name:GROVES-REHWALDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:CAROL
Other - Last Name:GROVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2960 CAMINO DIABLO STE 105
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3945
Mailing Address - Country:US
Mailing Address - Phone:800-892-2695
Mailing Address - Fax:
Practice Address - Street 1:2960 CAMINO DIABLO STE 105
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-3945
Practice Address - Country:US
Practice Address - Phone:800-892-2695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19537207QA0401X
CAG69202207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF65770Medicare UPIN
CA00G692020Medicare ID - Type Unspecified