Basic Information
Provider Information
NPI: 1396828687
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WALSH
FirstName: KATHLEEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NMW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 425 N DATE ST
Address2:  
City: ESCONDIDO
State: CA
PostalCode: 920253413
CountryCode: US
TelephoneNumber: 7607372035
FaxNumber: 7607412782
Practice Location
Address1: 401 E VALLEY PKWY
Address2:  
City: ESCONDIDO
State: CA
PostalCode: 920253317
CountryCode: US
TelephoneNumber: 7607372020
FaxNumber: 7607419380
Other Information
ProviderEnumerationDate: 10/23/2006
LastUpdateDate: 11/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
176B00000X1574CAY Other Service ProvidersMidwife 

No ID Information.


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