Provider Demographics
NPI:1548612054
Name:ESTOPINAL, KATHERINE RENDON (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:RENDON
Last Name:ESTOPINAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LOUISE
Other - Last Name:RENDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2068 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA
Mailing Address - State:CA
Mailing Address - Zip Code:93428-3014
Mailing Address - Country:US
Mailing Address - Phone:713-301-5236
Mailing Address - Fax:
Practice Address - Street 1:2150 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428-3022
Practice Address - Country:US
Practice Address - Phone:713-301-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA182616207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB422784Medicaid