Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | A84177 | CA |
NPI | 1144375791 |
---|---|
Provider Name | Dr. Katherine A Teeple |
First Address | San Clemente, CA 92672 |
Second Address | San Clemente, CA 92673-6355 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |