Provider Demographics
NPI:1073590196
Name:BABCOCK, KATRINA S (DO)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:S
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:SPEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:23242 HATTERAS ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3118
Mailing Address - Country:US
Mailing Address - Phone:805-379-9911
Mailing Address - Fax:805-230-2134
Practice Address - Street 1:325 ROLLING OAKS DR STE 220
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1085
Practice Address - Country:US
Practice Address - Phone:805-379-9911
Practice Address - Fax:805-379-0557
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7803208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A78030OtherBLUE SHIELD
CA020A78030OtherBLUE SHIELD
CA020A78030OtherBLUE SHIELD
CAW20A7803BMedicare ID - Type Unspecified