Provider Demographics
NPI:1932280765
Name:NITTA, KATHARINE C (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:C
Last Name:NITTA
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 1:355 PLACENTIA AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3302
Mailing Address - Country:US
Mailing Address - Phone:949-722-6644
Mailing Address - Fax:949-722-7875
Practice Address - Street 1:355 PLACENTIA AVE STE 206
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3302
Practice Address - Country:US
Practice Address - Phone:949-722-6644
Practice Address - Fax:949-722-7875
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54019208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE83558Medicare UPIN