Provider Demographics
NPI:1457423279
Name:MATHIS, CATHERINE F (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:F
Last Name:MATHIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:N
Other - Last Name:FROHOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1090
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-1090
Mailing Address - Country:US
Mailing Address - Phone:209-334-1800
Mailing Address - Fax:209-334-1430
Practice Address - Street 1:1234 E. NORTH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336
Practice Address - Country:US
Practice Address - Phone:209-824-2202
Practice Address - Fax:209-824-2205
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96553207V00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1386636165OtherGROUP NPI
CA00A965530Medicaid
CA68-0277719OtherTAX ID NUMBER
CA1386636165OtherGROUP NPI
CAZZZ14503ZMedicare PIN