Provider Demographics
NPI:1952447864
Name:WARDELL, KAREN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WARDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 S JAYTON LN
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4237
Mailing Address - Country:US
Mailing Address - Phone:760-632-5341
Mailing Address - Fax:
Practice Address - Street 1:5442 SYCUAN RD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-1816
Practice Address - Country:US
Practice Address - Phone:619-445-0707
Practice Address - Fax:619-445-5179
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68246208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics