Healthcare Provider Details

I. General information

NPI: 1467604645
Provider Name (Legal Business Name): KATHERINE LIVELY SWARTZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE ETTEN LIVELY DO

II. Dates (important events)

Enumeration Date: 10/19/2008
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

V. Phone/Fax

Practice location:
  • Phone: 757-619-7233
  • Fax: 619-532-9902
Mailing address:
  • Phone: 619-881-9159
  • Fax: 619-532-7721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number53526-021
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: