Provider Demographics
NPI:1427019397
Name:LIONEL B KATCHEM, D.O., A PROF. CORP.
Entity Type:Organization
Organization Name:LIONEL B KATCHEM, D.O., A PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:KATCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-373-0381
Mailing Address - Street 1:1246 E ARROW HWY STE B
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4955
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1246 E ARROW HWY STE B
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4955
Practice Address - Country:US
Practice Address - Phone:909-373-0381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4524261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care