Provider Demographics
NPI:1609450774
Name:NORIEGA, KATHERINE ANGELA
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANGELA
Last Name:NORIEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 S ARAPAHO DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-2408
Mailing Address - Country:US
Mailing Address - Phone:714-292-0345
Mailing Address - Fax:
Practice Address - Street 1:24330 EL TORO RD
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2775
Practice Address - Country:US
Practice Address - Phone:949-830-0391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH129194183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician