Provider Demographics
NPI:1629057005
Name:KATER, VINCENT PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:PAUL
Last Name:KATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 ALVARADO RD STE 305
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5266
Mailing Address - Country:US
Mailing Address - Phone:619-583-4303
Mailing Address - Fax:619-583-3803
Practice Address - Street 1:6719 ALVARADO RD
Practice Address - Street 2:SUITE305
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5270
Practice Address - Country:US
Practice Address - Phone:619-583-4303
Practice Address - Fax:619-583-3803
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G45851Medicaid
CA1003340001Medicare NSC
CA00G45851Medicaid
CAG45851Medicare PIN