Provider Demographics
NPI:1801963277
Name:DEUGARTE, CATHERINE MARIN (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARIN
Last Name:DEUGARTE
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 1:10921 WILSHIRE BLVD
Mailing Address - Street 2:STE 702
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3906
Mailing Address - Country:US
Mailing Address - Phone:310-873-1800
Mailing Address - Fax:
Practice Address - Street 1:10921 WILSHIRE BLVD
Practice Address - Street 2:STE 702
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3906
Practice Address - Country:US
Practice Address - Phone:310-873-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084843207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H262210OtherBLUE CROSS-BLUE CROSS
CD084843OtherCHAMPUS-CHAMPUS
CD084843OtherCOMMERCIAL-COMMERCIAL NUMBER
MI477697210Medicaid
0H26221141Medicare ID - Type Unspecified
MI477697210Medicaid