Provider Demographics
NPI:1477210664
Name:MUTUA, CATHERINE N
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:N
Last Name:MUTUA
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 1:2004 THELMA LOOP
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-7211
Mailing Address - Country:US
Mailing Address - Phone:510-292-1577
Mailing Address - Fax:
Practice Address - Street 1:2004 THELMA LOOP
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-7211
Practice Address - Country:US
Practice Address - Phone:510-292-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA831549163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse