Individual
KATHERINE KAWAKAMI SOUBRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
2701 ATLANTIC AVE, SUITE A, LONG BEACH, CA 90806-2701
(562) 595-4827
(562) 981-6898
Mailing address
12122 DIAMOND ST, GARDEN GROVE, CA 92845-1819
(714) 897-9748
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
301288
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
301288
NURSE PRACTITIONER
CA
Enumeration date
11/03/2006
Last updated
07/08/2007
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