Basic Information
| Provider Information | |||||||||
| NPI: | 1508129818 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COUGHLIN | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8555 AERO DR STE 104 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585985472 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3003 HEALTH CENTER DR | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921232700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8589393400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2012 | ||||||||
| LastUpdateDate: | 06/26/2019 | ||||||||
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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 | 208000000X | MD454306 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080N0001X | MT201075 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.