Basic Information
| Provider Information | |||||||||
| NPI: | 1477089175 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OUTCALT | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | RACHELLE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5525 GROSSMONT CENTER DR | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919423009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992900 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8701 CUYAMACA ST | ||||||||
| Address2: | |||||||||
| City: | SANTEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992715 | ||||||||
| FaxNumber: | 6195688081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2017 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A18248 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.