Provider Demographics
NPI:1598705469
Name:DIXON, KATHARINE N (MD)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:N
Last Name:DIXON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:N
Other - Last Name:COLLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:STE 970
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1234
Practice Address - Country:US
Practice Address - Phone:858-558-2731
Practice Address - Fax:858-452-5905
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC343022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A35579Medicare UPIN
CAWC34302AMedicare PIN
CAW416Medicare PIN