Provider Demographics
NPI:1073811204
Name:KATAZA, RICHARD BAKALUBA (RN)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BAKALUBA
Last Name:KATAZA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1466
Mailing Address - Country:US
Mailing Address - Phone:508-366-5541
Mailing Address - Fax:
Practice Address - Street 1:15 FOREST LN
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1466
Practice Address - Country:US
Practice Address - Phone:508-366-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2259113163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology