Provider Demographics
NPI:1669836862
Name:MURPHY, CATHLEEN A
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:A
Last Name:MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 LAUREL ST
Mailing Address - Street 2:908
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3113
Mailing Address - Country:US
Mailing Address - Phone:650-867-2345
Mailing Address - Fax:
Practice Address - Street 1:751 LAUREL ST
Practice Address - Street 2:908
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3113
Practice Address - Country:US
Practice Address - Phone:650-867-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338900261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center