Provider Demographics
NPI:1497744023
Name:NANNINGA, CATHI LEE (MD)
Entity Type:Individual
Prefix:
First Name:CATHI
Middle Name:LEE
Last Name:NANNINGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 WILSHIRE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010
Mailing Address - Country:US
Mailing Address - Phone:323-938-2942
Mailing Address - Fax:323-938-8952
Practice Address - Street 1:4727 WILSHIRE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010
Practice Address - Country:US
Practice Address - Phone:323-938-2942
Practice Address - Fax:323-938-8952
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG045964207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G0459640Medicaid
E02662Medicare UPIN
CA00G0459640Medicaid