Healthcare Provider Details

I. General information

NPI: 1982916375
Provider Name (Legal Business Name): KATHERINE DANIELLE WILLIAMSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23321 EL TORO RD SUITE F
LAKE FOREST CA
92630-4825
US

IV. Provider business mailing address

23321 EL TORO RD SUITE F
LAKE FOREST CA
92630-4825
US

V. Phone/Fax

Practice location:
  • Phone: 949-388-1798
  • Fax:
Mailing address:
  • Phone: 949-388-1798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA112985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: