Provider Demographics
NPI:1790085116
Name:CAYABYAB, KATRINE LISETTE CHUA (RPH)
Entity Type:Individual
Prefix:
First Name:KATRINE LISETTE
Middle Name:CHUA
Last Name:CAYABYAB
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3437
Mailing Address - Country:US
Mailing Address - Phone:707-225-3040
Mailing Address - Fax:707-225-3042
Practice Address - Street 1:3375 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3437
Practice Address - Country:US
Practice Address - Phone:707-225-3040
Practice Address - Fax:707-225-3042
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist