Provider Demographics
NPI:1912258781
Name:ESPANA, KATHERINE VIVIANA
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:VIVIANA
Last Name:ESPANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 BLAKE ST APT 216
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2853
Mailing Address - Country:US
Mailing Address - Phone:323-821-2407
Mailing Address - Fax:
Practice Address - Street 1:225 37TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-4324
Practice Address - Country:US
Practice Address - Phone:650-573-3474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program