Provider Demographics
NPI:1801020334
Name:BOLLIN, KATHRYN B (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:B
Last Name:BOLLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:BLOUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:619-849-4469
Mailing Address - Fax:619-849-1547
Practice Address - Street 1:501 WASHINGTON ST STE 508
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:619-849-4469
Practice Address - Fax:619-849-1547
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA131480207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ723976Medicaid
AZZ90193Medicare PIN