Healthcare Provider Details

I. General information

NPI: 1477089175
Provider Name (Legal Business Name): KATHLEEN RACHELLE OUTCALT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 10/05/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 CUYAMACA ST
SANTEE CA
92071
US

IV. Provider business mailing address

5525 GROSSMONT CENTER DR
LA MESA CA
91942-3009
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2715
  • Fax: 619-568-8081
Mailing address:
  • Phone: 858-499-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A18248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: