Provider Demographics
NPI:1669052882
Name:KAZARIAN, KATRINA LEAH
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:LEAH
Last Name:KAZARIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-3602
Mailing Address - Country:US
Mailing Address - Phone:707-345-4012
Mailing Address - Fax:844-388-6167
Practice Address - Street 1:137 E OAK ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-3610
Practice Address - Country:US
Practice Address - Phone:707-345-4012
Practice Address - Fax:844-388-6167
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker