Healthcare Provider Details

I. General information

NPI: 1801020334
Provider Name (Legal Business Name): KATHRYN B BOLLIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN BLOUNT

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WASHINGTON ST STE 508
SAN DIEGO CA
92103-2238
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 619-849-4469
  • Fax: 619-849-1547
Mailing address:
  • Phone: 619-849-4469
  • Fax: 619-849-1547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA131480
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA131480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: