MEDICARE: DR. KATHERINE HELEN MEKOLIK M.D.

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	207Q00000X	Family Medicine Physician	A89482	CA

General Provider Information

NPI Number	:	1487680112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE HELEN MEKOLIK M.D.

Provider Business Mailing Address
First Line	:	6911 CONVOY CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6911 CONVOY CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1014
Country	:	US
Telephone Number	:	619-644-6500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	04/22/2024

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