Provider Demographics
NPI:1881957686
Name:STINSON, KATRINA DIANN (MD)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:DIANN
Last Name:STINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21634 RETREAT PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMESCAL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92883-6100
Mailing Address - Country:US
Mailing Address - Phone:951-493-8134
Mailing Address - Fax:951-826-8134
Practice Address - Street 1:21634 RETREAT PKWY
Practice Address - Street 2:
Practice Address - City:TEMESCAL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92883-6100
Practice Address - Country:US
Practice Address - Phone:951-493-8134
Practice Address - Fax:951-826-8134
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301117483207V00000X
NE27955207V00000X
NY306612-01207V00000X
CAC174429207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN