MEDICARE: KATHRYN BEDOR

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	171W00000X	Contractor	L9694	CA

General Provider Information

NPI Number	:	1285379263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN BEDOR

Provider Business Mailing Address
First Line	:	3632 1/2 MEADE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-3619
Country	:	US
Telephone Number	:	206-829-0218
Fax Number	:

Provider Business Practice Location Address
First Line	:	9750 MIRAMAR RD STE 130
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4561
Country	:	US
Telephone Number	:	206-829-0218
Fax Number	:

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

Provider Enumeration Date	:	05/03/2022
Last Update Date	:	05/03/2022

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Directions to “ KATHRYN BEDOR ” Practice Location

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