Provider Demographics
NPI:1336234210
Name:RIGONAN, KATHRYN RUBIO (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RUBIO
Last Name:RIGONAN
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 1:11100 WARNER AVE
Mailing Address - Street 2:SUITE 154
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-754-0100
Mailing Address - Fax:714-754-6806
Practice Address - Street 1:11100 WARNER AVE
Practice Address - Street 2:SUITE 154
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-754-0100
Practice Address - Fax:714-754-6806
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A512200OtherBCBS
CA00512200Medicaid
F60275Medicare UPIN
CA00512200Medicaid