Provider Demographics
NPI:1598102584
Name:HALLORAN, KATRINA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:HALLORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2315 STOCKTON BLVD
Mailing Address - Street 2:DEPT OF PEDIATRICS, NEONATOLOGY
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2201
Mailing Address - Country:US
Mailing Address - Phone:916-734-8672
Mailing Address - Fax:916-456-4490
Practice Address - Street 1:2516 STOCKTON BLVD
Practice Address - Street 2:DEPT OF PEDIATRICS, NEONATOLOGY
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2208
Practice Address - Country:US
Practice Address - Phone:916-734-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA141346208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics