Provider Demographics
NPI:1639104383
Name:WOODHALL, KATRINA E (MD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:E
Last Name:WOODHALL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:31915 RANCHO CALIFORNIA RD
Mailing Address - Street 2:STE 200216
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5132
Mailing Address - Country:US
Mailing Address - Phone:858-401-2738
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA89622207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00611073OtherRAILROAD MEDICARE
CAP00611073OtherRAILROAD MEDICARE
CABN523YMedicare PIN