Provider Demographics
NPI:1659168284
Name:SO, MARIA KATRINA
Entity type:Individual
Prefix:
First Name:MARIA KATRINA
Middle Name:
Last Name:SO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 GREEN BLOSSOM CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2345
Mailing Address - Country:US
Mailing Address - Phone:916-873-4219
Mailing Address - Fax:
Practice Address - Street 1:2234 GREEN BLOSSOM CT
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2345
Practice Address - Country:US
Practice Address - Phone:916-873-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program