Healthcare Provider Details

I. General information

NPI: 1952627937
Provider Name (Legal Business Name): CATHERINE CARROLL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE STOTT MD

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11865 CARMEL MOUNTAIN RD STE 1104
SAN DIEGO CA
92128-4610
US

IV. Provider business mailing address

9850 GENESEE AVE STE 320
LA JOLLA CA
92037-1208
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-1212
  • Fax: 858-795-1195
Mailing address:
  • Phone: 858-554-1212
  • Fax: 858-795-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA117855
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA117855
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: