Provider Demographics
NPI:1780745448
Name:LIEP, CATAREYA P (MD)
Entity type:Individual
Prefix:
First Name:CATAREYA
Middle Name:P
Last Name:LIEP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 N CAMPUS AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4229
Mailing Address - Country:US
Mailing Address - Phone:909-988-8203
Mailing Address - Fax:909-988-5006
Practice Address - Street 1:437 N CAMPUS AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4229
Practice Address - Country:US
Practice Address - Phone:909-988-8203
Practice Address - Fax:909-988-5006
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78275208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A782750Medicaid