Provider Demographics
NPI:1093769150
Name:MCDONALD, M KATHY (MD)
Entity Type:Individual
Prefix:DR
First Name:M
Middle Name:KATHY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:31493 RANCHO PUEBLO RD, SUITE # 107
Mailing Address - Street 2:THE MCDONALD CLINIC, INC.
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592
Mailing Address - Country:US
Mailing Address - Phone:951-303-3337
Mailing Address - Fax:951-303-2810
Practice Address - Street 1:31493 RANCHO PUEBLO RD, SUITE # 107
Practice Address - Street 2:THE MCDONALD CLINIC, INC.
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:951-303-3337
Practice Address - Fax:951-303-2810
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93619207Q00000X
WAMD00042460207Q00000X
MT9933207Q00000X
ND9247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDH78201Medicare UPIN