1942196373 NPI number — KATAHNA AALIYAH CHENELLE DIXIE

Table of content: KATAHNA AALIYAH CHENELLE DIXIE (NPI 1942196373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942196373 NPI number — KATAHNA AALIYAH CHENELLE DIXIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXIE
Provider First Name:
KATAHNA
Provider Middle Name:
AALIYAH CHENELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942196373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6612 CANTER COVE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTVALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92880-3721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-707-8081
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
495 E RINCON ST STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92879-1379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-821-1491
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2025

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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