MEDICARE: DARYL F CATHERWOOD

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	122300000X	Dentist	38012	CA

General Provider Information

NPI Number	:	1801077029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL F CATHERWOOD

Provider Business Mailing Address
First Line	:	1001 B AVE
Second Line	:	STE.105
City	:	CORONADO
State	:	CA
Zip	:	92118-3421
Country	:	US
Telephone Number	:	619-437-8722
Fax Number	:	619-437-4167

Provider Business Practice Location Address
First Line	:	1001 B AVE
Second Line	:	STE.105
City	:	CORONADO
State	:	CA
Zip	:	92118-3421
Country	:	US
Telephone Number	:	619-437-8722
Fax Number	:	619-437-4167

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

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	11/15/2007

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Directions to “ DARYL F CATHERWOOD ” Practice Location

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