Healthcare Provider Details

I. General information

NPI: 1114285491
Provider Name (Legal Business Name): KATHLEEN ANN LYTAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ANN LINZMEIER

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 E FOOTHILL BLVD
PASADENA CA
91107-3103
US

IV. Provider business mailing address

3280 E FOOTHILL BLVD
PASADENA CA
91107-3103
US

V. Phone/Fax

Practice location:
  • Phone: 800-954-8000
  • Fax:
Mailing address:
  • Phone: 800-954-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA128613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: