Healthcare Provider Details

I. General information

NPI: 1235367327
Provider Name (Legal Business Name): PAULA WITHERSPOON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34520 BOB WILSON DR DEPARTMENT OF PEDIATRICS
SAN DIEGO CA
92134-2030
US

IV. Provider business mailing address

34520 BOB WILSON DR DEPARTMENT OF PEDIATRICS
SAN DIEGO CA
92134-2030
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7070
  • Fax:
Mailing address:
  • Phone: 619-532-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number252650
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA139073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: