Provider Demographics
NPI:1932643962
Name:HAUSMAN, KATRINA MARISA
Entity Type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:MARISA
Last Name:HAUSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATRINA
Other - Middle Name:MARISA
Other - Last Name:ULLOA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:866 RETTIG AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89044-9522
Mailing Address - Country:US
Mailing Address - Phone:714-624-8896
Mailing Address - Fax:
Practice Address - Street 1:5258 S EASTERN AVE STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2327
Practice Address - Country:US
Practice Address - Phone:702-464-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator