Provider Demographics
NPI:1518055615
Name:LICHTENSTEIN, KATHRYN A (PAC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:LICHTENSTEIN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S PIERCE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4124
Mailing Address - Country:US
Mailing Address - Phone:619-668-4700
Mailing Address - Fax:619-668-0049
Practice Address - Street 1:300 S PIERCE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4124
Practice Address - Country:US
Practice Address - Phone:619-668-4700
Practice Address - Fax:619-668-0049
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19904363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical