MEDICARE: DR. HILARY BLYTHE KRAUSE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A90650	CA

General Provider Information

NPI Number	:	1275626905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HILARY BLYTHE KRAUSE M.D.

Provider Business Mailing Address
First Line	:	3500 5TH AVE STE 101
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5020
Country	:	US
Telephone Number	:	619-295-3911
Fax Number	:	619-295-4356

Provider Business Practice Location Address
First Line	:	3500 5TH AVE STE 101
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5020
Country	:	US
Telephone Number	:	619-295-3911
Fax Number	:	619-295-4356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	10/15/2023

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