Provider Demographics
NPI:1497982888
Name:MUTH, NATALIE D (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:D
Last Name:MUTH
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4802
Mailing Address - Country:US
Mailing Address - Phone:858-636-4300
Mailing Address - Fax:858-636-4319
Practice Address - Street 1:2067 W. VISTA WAY
Practice Address - Street 2:SUITE 180
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6033
Practice Address - Country:US
Practice Address - Phone:760-945-3434
Practice Address - Fax:760-945-6761
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2015-10-02
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Provider Licenses
StateLicense IDTaxonomies
CAA116344208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092060Medicaid