Provider Demographics
NPI:1669442307
Name:KATRINA SPEARS BABCOCK DO CORPORATION
Entity type:Organization
Organization Name:KATRINA SPEARS BABCOCK DO CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:805-379-9911
Mailing Address - Street 1:325 ROLLING OAKS DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1201
Mailing Address - Country:US
Mailing Address - Phone:805-379-9911
Mailing Address - Fax:805-230-2134
Practice Address - Street 1:23242 HATTERAS ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3118
Practice Address - Country:US
Practice Address - Phone:805-379-9911
Practice Address - Fax:805-230-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
610121401OtherUS DEPT OF LABOR
610121400OtherUS DEPT OF LABOR