1386008779 NPI number — DR. NICOLE KRISTEN CATES DPM

Table of content: DR. NICOLE KRISTEN CATES DPM (NPI 1386008779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386008779 NPI number — DR. NICOLE KRISTEN CATES DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CATES
Provider First Name:
NICOLE
Provider Middle Name:
KRISTEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AVERSA
Provider Other First Name:
NICOLE
Provider Other Middle Name:
KRISTEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386008779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2299 POST ST STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94115-3443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-923-0992
Provider Business Mailing Address Fax Number:
415-923-1036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2299 POST ST STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94115-3443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-923-0992
Provider Business Practice Location Address Fax Number:
415-923-1036
Provider Enumeration Date:
04/11/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: E5708 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)