MEDICARE: KATRINA E WOODHALL, MD AND ASSOCIATES, A PROFESSIONAL MEDICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	A89622	CA

General Provider Information

NPI Number	:	1043528177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATRINA E WOODHALL, MD AND ASSOCIATES, A PROFESSIONAL MEDICAL

Provider Business Mailing Address
First Line	:	PO BOX 642
Second Line	:
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-0642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 WASHINGTON ST STE 502
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2238
Country	:	US
Telephone Number	:	619-542-0013
Fax Number	:	858-257-1648

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	KATRINA WOODHALL
Credential	:	MD
Telephone Number	:	858-257-1621

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	03/17/2018

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