Provider Demographics
NPI:1982916375
Name:WILLIAMSON, KATHERINE DANIELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:DANIELLE
Last Name:WILLIAMSON
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 1:23321 EL TORO RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4825
Mailing Address - Country:US
Mailing Address - Phone:949-388-1798
Mailing Address - Fax:
Practice Address - Street 1:23321 EL TORO RD
Practice Address - Street 2:SUITE F
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4825
Practice Address - Country:US
Practice Address - Phone:949-388-1798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112985208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics