Provider Demographics
NPI:1073582482
Name:KATARIA, PURSHOTAM B (MD)
Entity Type:Individual
Prefix:DR
First Name:PURSHOTAM
Middle Name:B
Last Name:KATARIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2006
Mailing Address - Country:US
Mailing Address - Phone:951-735-6000
Mailing Address - Fax:951-735-6960
Practice Address - Street 1:112 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2006
Practice Address - Country:US
Practice Address - Phone:951-735-6000
Practice Address - Fax:951-735-6960
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA434562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A434560Medicaid
CAE33594Medicare UPIN