Provider Demographics
NPI:1972752095
Name:THEO, CATHERINE (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:THEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 ARENA BLVD
Mailing Address - Street 2:SUITE: 160
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2309
Mailing Address - Country:US
Mailing Address - Phone:916-576-7898
Mailing Address - Fax:916-285-0338
Practice Address - Street 1:3061 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4009
Practice Address - Country:US
Practice Address - Phone:415-292-3440
Practice Address - Fax:415-561-0244
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1070632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program