Provider Demographics
NPI:1710930789
Name:KATRINA DI PASQUA DPM INC
Entity Type:Organization
Organization Name:KATRINA DI PASQUA DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DI PASQUA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:707-224-8865
Mailing Address - Street 1:2017 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1213
Mailing Address - Country:US
Mailing Address - Phone:707-224-8865
Mailing Address - Fax:707-226-6968
Practice Address - Street 1:2017 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1213
Practice Address - Country:US
Practice Address - Phone:707-224-8865
Practice Address - Fax:707-226-6968
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KATRINA DI PASQUA DPM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE38550213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E38550Medicaid
CA000E38550Medicaid
U36232Medicare UPIN
CA5533750001Medicare NSC