Provider Demographics
NPI:1487491585
Name:FISHER, KATRINA (DACM)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9314 HILLERY DR APT 6104
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2878
Mailing Address - Country:US
Mailing Address - Phone:786-457-1734
Mailing Address - Fax:
Practice Address - Street 1:24619 WASHINGTON AVE STE 206
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8228
Practice Address - Country:US
Practice Address - Phone:951-698-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19144171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist