Provider Demographics
NPI:1093160459
Name:HEYRANA, KATRINA J
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:J
Last Name:HEYRANA
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 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-423-9268
Mailing Address - Fax:
Practice Address - Street 1:444 S SAN VICENTE BLVD STE 1002
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4170
Practice Address - Country:US
Practice Address - Phone:310-423-9268
Practice Address - Fax:310-423-9939
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA168712207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program