Provider Demographics
NPI:1346419678
Name:POKORSKI, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:POKORSKI
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 1:3701 BIRCH ST
Mailing Address - Street 2:200
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2618
Mailing Address - Country:US
Mailing Address - Phone:949-722-7662
Mailing Address - Fax:949-631-6585
Practice Address - Street 1:3701 BIRCH ST
Practice Address - Street 2:200
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2618
Practice Address - Country:US
Practice Address - Phone:949-722-7662
Practice Address - Fax:949-631-6585
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA928015133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic