Provider Demographics
NPI:1699242776
Name:CUNHA, KATHERINE MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MICHELLE
Last Name:CUNHA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:MICHELLE
Other - Last Name:CUNHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MONTELEONE
Mailing Address - Street 1:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2489
Practice Address - Country:US
Practice Address - Phone:714-252-9415
Practice Address - Fax:714-963-8407
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009473363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty