Provider Demographics
NPI:1619359510
Name:HAGMANN, KATHERINE (DPM)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:HAGMANN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17215 STUDEBAKER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2521
Mailing Address - Country:US
Mailing Address - Phone:310-750-4511
Mailing Address - Fax:424-282-8244
Practice Address - Street 1:825 S ALMA SCHOOL RD APT 113
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2006
Practice Address - Country:US
Practice Address - Phone:608-461-0191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1045213ES0103X
IL135.000879213ES0103X
AZPOD-001093213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery