Provider Demographics
NPI:1043528177
Name:KATRINA E WOODHALL, MD AND ASSOCIATES, A PROFESSIONAL MEDICAL
Entity Type:Organization
Organization Name:KATRINA E WOODHALL, MD AND ASSOCIATES, A PROFESSIONAL MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-257-1621
Mailing Address - Street 1:PO BOX 642
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-0642
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 WASHINGTON ST STE 502
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2238
Practice Address - Country:US
Practice Address - Phone:619-542-0013
Practice Address - Fax:858-257-1648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89622207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty