Basic Information
| Provider Information | |||||||||
| NPI: | 1104151133 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRILL | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6615 E PACIFIC COAST HWY | ||||||||
| Address2: | STE 255 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908034227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627996700 | ||||||||
| FaxNumber: | 5627996733 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 E FOOTHILL BLVD | ||||||||
| Address2: | |||||||||
| City: | RIALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923765230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094219301 | ||||||||
| FaxNumber: | 9094219219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2009 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.