=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093769150
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | M KATHY MCDONALD M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2006
-----------------------------------------------------
Last Update Date | 06/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31493 RANCHO PUEBLO RD, SUITE # 107 THE MCDONALD CLINIC, INC.
-----------------------------------------------------
City | TEMECULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-303-3337
-----------------------------------------------------
Fax | 951-303-2810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31493 RANCHO PUEBLO RD, SUITE # 107 THE MCDONALD CLINIC, INC.
-----------------------------------------------------
City | TEMECULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-303-3337
-----------------------------------------------------
Fax | 951-303-2810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A93619
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD00042460
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 9933
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 9247
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------