Provider Demographics
NPI:1720104722
Name:KING, CATHY E (RN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:E
Last Name:KING
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 TONNER DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-1651
Mailing Address - Country:US
Mailing Address - Phone:951-236-4195
Mailing Address - Fax:
Practice Address - Street 1:33353 YUCAIPA BLVD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2018
Practice Address - Country:US
Practice Address - Phone:909-790-5071
Practice Address - Fax:909-790-5774
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288395363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics