Basic Information
| Provider Information | |||||||||
| NPI: | 1285086702 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONOVER | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | CONOVER | ||||||||
| OtherFirstName: | KATE | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3020 CHILDREN'S WAY, MC 5018 | ||||||||
| Address2: | RADY CHILDREN'S OUTPATIENT PSYCHIATRY | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193600643 | ||||||||
| FaxNumber: | 8589666733 | ||||||||
| Practice Location | |||||||||
| Address1: | 3020 CHILDRENS WAY # MC5018 | ||||||||
| Address2: | RADY CHILDREN'S OUTPATIENT PSYCHIATRY | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921234223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193600643 | ||||||||
| FaxNumber: | 8589666733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2016 | ||||||||
| LastUpdateDate: | 07/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.