Provider Demographics
NPI:1881138824
Name:MARTIN, KATHERINE PICCIANO
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:PICCIANO
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:CHASE
Other - Last Name:PICCIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1845 ADRIANA CT
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7043
Mailing Address - Country:US
Mailing Address - Phone:706-833-8737
Mailing Address - Fax:
Practice Address - Street 1:1845 ADRIANA CT
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7043
Practice Address - Country:US
Practice Address - Phone:706-833-8737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH75127183500000X
GARPH029362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist