Healthcare Provider Details

I. General information

NPI: 1164493151
Provider Name (Legal Business Name): ELIZABETH KLINE SATTER MD, MPH, MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2565 INGULF PLACE
SAN DIEGO CA
92110
US

IV. Provider business mailing address

2565 INGULF PL
SAN DIEGO CA
92110-2361
US

V. Phone/Fax

Practice location:
  • Phone: 619-446-1971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number37672
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number98919
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA98919
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number037672
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA98919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: