Provider Demographics
NPI:1710151915
Name:KATAHDIN, EVIE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:EVIE
Middle Name:
Last Name:KATAHDIN
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 WESTERLY PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2322
Mailing Address - Country:US
Mailing Address - Phone:949-660-1399
Mailing Address - Fax:949-660-1333
Practice Address - Street 1:4121 WESTERLY PL
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2322
Practice Address - Country:US
Practice Address - Phone:949-660-1399
Practice Address - Fax:949-660-1333
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9988171100000X
CAND 33175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist