1306555834 NPI number — DR. KATELYNN ANN LILLIBRIDGE OTD

Table of content: DR. KATELYNN ANN LILLIBRIDGE OTD (NPI 1306555834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306555834 NPI number — DR. KATELYNN ANN LILLIBRIDGE OTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LILLIBRIDGE
Provider First Name:
KATELYNN
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OTD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIMEBURNER
Provider Other First Name:
KATELYNN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306555834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9300 VALLEY CHILDRENS PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADERA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93636-8761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-353-6800
Provider Business Mailing Address Fax Number:
559-353-6813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9300 VALLEY CHILDRENS PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADERA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93636-8761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-353-6800
Provider Business Practice Location Address Fax Number:
559-353-6813
Provider Enumeration Date:
11/23/2022

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: 225X00000X , with the licence number:  23367 , 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)





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