Provider Demographics
NPI:1972929404
Name:LAIS, KATHERINE ROSE (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ROSE
Last Name:LAIS
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:ROSE
Other - Last Name:GOEHRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, PMHNP-BC
Mailing Address - Street 1:3050 RUE DORLEANS
Mailing Address - Street 2:UNIT 382
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5927
Mailing Address - Country:US
Mailing Address - Phone:512-571-0440
Mailing Address - Fax:
Practice Address - Street 1:855 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3819
Practice Address - Country:US
Practice Address - Phone:619-440-2751
Practice Address - Fax:619-440-2945
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA840984163W00000X
CA95002763363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse