Basic Information
| Provider Information | |||||||||
| NPI: | 1982290532 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KATALYST MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8929 UNIVERSITY CENTER LN STE 201 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921221008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582942201 | ||||||||
| FaxNumber: | 8586252020 | ||||||||
| Practice Location | |||||||||
| Address1: | 8929 UNIVERSITY CENTER LN STE 201 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921221008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582942201 | ||||||||
| FaxNumber: | 8586252020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2020 | ||||||||
| LastUpdateDate: | 12/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | CAMHI | ||||||||
| AuthorizedOfficialFirstName: | SETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8582942201 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.