MEDICARE: KATRINA E WOODHALL 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	207N00000X	Dermatology Physician	A89622	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00611073	OTHER	CA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1639104383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA E WOODHALL M.D.

Provider Business Mailing Address
First Line	:	31915 RANCHO CALIFORNIA RD
Second Line	:	STE 200216
City	:	TEMECULA
State	:	CA
Zip	:	92591-5132
Country	:	US
Telephone Number	:	858-401-2738
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	12/30/2020

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