Provider Demographics
NPI:1790887610
Name:KATNENI, RATNAJA (MD)
Entity Type:Individual
Prefix:
First Name:RATNAJA
Middle Name:
Last Name:KATNENI
Suffix:
Gender:F
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:PO BOX 1584
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-0584
Mailing Address - Country:US
Mailing Address - Phone:657-218-4082
Mailing Address - Fax:657-218-4161
Practice Address - Street 1:20241 SW BIRCH ST STE 104
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1784
Practice Address - Country:US
Practice Address - Phone:949-490-4044
Practice Address - Fax:657-218-4161
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC134129207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB237060Medicare PIN