Provider Demographics
NPI:1497038038
Name:NICOLAS, CATHERINE SOBERANO
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:SOBERANO
Last Name:NICOLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CATHY
Other - Middle Name:SOBERANO
Other - Last Name:NICOLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:549 FAIRHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7271
Mailing Address - Country:US
Mailing Address - Phone:707-557-0103
Mailing Address - Fax:707-557-0113
Practice Address - Street 1:210 AMERICAN CANYON RD
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-3004
Practice Address - Country:US
Practice Address - Phone:707-557-0103
Practice Address - Fax:707-557-0113
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist