Provider Demographics
NPI:1487840211
Name:DI PASQUA, KATRINA B (DPM)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:B
Last Name:DI PASQUA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1213
Mailing Address - Country:US
Mailing Address - Phone:707-224-8865
Mailing Address - Fax:707-226-6968
Practice Address - Street 1:2017 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1213
Practice Address - Country:US
Practice Address - Phone:707-224-8865
Practice Address - Fax:707-226-6968
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE38550213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E38550Medicare PIN