Provider Demographics
NPI:1033649405
Name:CATA, CORNELIA
Entity Type:Individual
Prefix:
First Name:CORNELIA
Middle Name:
Last Name:CATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 MELVIN DR
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4930
Mailing Address - Country:US
Mailing Address - Phone:916-470-2978
Mailing Address - Fax:
Practice Address - Street 1:5000 MELVIN DR
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4930
Practice Address - Country:US
Practice Address - Phone:916-470-2978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347002550310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA347002550OtherASSISTED LIVING FACILITY