Provider Demographics
NPI:1477089175
Name:OUTCALT, KATHLEEN RACHELLE (DO)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:RACHELLE
Last Name:OUTCALT
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:5525 GROSSMONT CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3009
Mailing Address - Country:US
Mailing Address - Phone:858-499-2900
Mailing Address - Fax:
Practice Address - Street 1:8701 CUYAMACA ST
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071
Practice Address - Country:US
Practice Address - Phone:858-499-2715
Practice Address - Fax:619-568-8081
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A18248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine