Healthcare Provider Details

I. General information

NPI: 1033642574
Provider Name (Legal Business Name): KATHERINE MARIE DOVE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE M DOVE M.D.

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 FROST ST
SAN DIEGO CA
92123-2746
US

IV. Provider business mailing address

3020 CHILDRENS WAY # MC5003
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-5819
  • Fax:
Mailing address:
  • Phone: 858-309-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA184759
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA184759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: