Healthcare Provider Details

I. General information

NPI: 1134804610
Provider Name (Legal Business Name): KATIE LYNN DOOLITTLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE
LA JOLLA CA
92037-1224
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-626-5900
  • Fax:
Mailing address:
  • Phone: 858-626-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62704
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPA62704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: