Individual
KATIE ELM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3313 GREENLEAF DR, BREA, CA 92823-6326
(949) 939-7493
(949) 939-7493
Mailing address
3313 GREENLEAF DR, BREA, CA 92823-6326
(949) 939-7493
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000035600
BOARD OR CERTIFICATION
CA
Enumeration date
03/15/2018
Last updated
09/23/2019
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