Provider Demographics
NPI:1497007124
Name:POTTHAST, KATHARINE (LM)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:POTTHAST
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17399 HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-7092
Mailing Address - Country:US
Mailing Address - Phone:714-812-5283
Mailing Address - Fax:
Practice Address - Street 1:17399 HEIGHTS LN
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-7092
Practice Address - Country:US
Practice Address - Phone:714-812-5283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife