Provider Demographics
NPI:1861448763
Name:ANGLIN, KATHERINE (MD, MS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:ANGLIN
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12380 HESPERIA RD STE 4
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5814
Mailing Address - Country:US
Mailing Address - Phone:760-261-5219
Mailing Address - Fax:
Practice Address - Street 1:12408 HESPERIA RD STE 21
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7718
Practice Address - Country:US
Practice Address - Phone:760-245-4747
Practice Address - Fax:442-242-6796
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11908207Q00000X
MN43596207Q00000X
CAC144046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861448763OtherFAMILY MEDICINE
MN530046100Medicaid
MN080013603Medicare ID - Type UnspecifiedMEDICARE