Provider Demographics
NPI:1356581847
Name:KATHRYN RIGONAN MD INC A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:KATHRYN RIGONAN MD INC A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:RUBIO
Authorized Official - Last Name:RIGONAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-754-0100
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:92708-7506
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:92708-7506
Practice Address - Country:US
Practice Address - Phone:714-754-0100
Practice Address - Fax:714-754-6806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KATHRYN RIGONAN MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-24
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336234210OtherINDIVIDUAL NPI
CAF60275Medicare UPIN