Provider Demographics
NPI:1740625607
Name:KATRINA PLATT DO PC
Entity type:Organization
Organization Name:KATRINA PLATT DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-641-6708
Mailing Address - Street 1:5 E CITRUS AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4736
Mailing Address - Country:US
Mailing Address - Phone:909-307-6007
Mailing Address - Fax:
Practice Address - Street 1:2388 GRACE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-4909
Practice Address - Country:US
Practice Address - Phone:909-641-6708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10988261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care