Provider Demographics
NPI:1457470148
Name:KATAKA, SUSANA WAYETA (NP)
Entity type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:WAYETA
Last Name:KATAKA
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:WAYETA
Other - Last Name:KATAKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC, MSN
Mailing Address - Street 1:12645 MEMORIAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4898
Mailing Address - Country:US
Mailing Address - Phone:713-291-4084
Mailing Address - Fax:
Practice Address - Street 1:2401 E ORANGEBURG AVE STE 330
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3396
Practice Address - Country:US
Practice Address - Phone:209-383-5871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX680495207V00000X, 363LW0102X
TXAP113842363LW0102X
CT11938363LW0102X
CA95028644363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health