Provider Demographics
NPI:1801077029
Name:CATHERWOOD, DARYL F
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:F
Last Name:CATHERWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 B AVE
Mailing Address - Street 2:STE.105
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3421
Mailing Address - Country:US
Mailing Address - Phone:619-437-8722
Mailing Address - Fax:619-437-4167
Practice Address - Street 1:1001 B AVE
Practice Address - Street 2:STE.105
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-3421
Practice Address - Country:US
Practice Address - Phone:619-437-8722
Practice Address - Fax:619-437-4167
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38012122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist