1093769150 NPI number — DR. M KATHY MCDONALD M.D.

Table of content: DR. M KATHY MCDONALD M.D. (NPI 1093769150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093769150 NPI number — DR. M KATHY MCDONALD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDONALD
Provider First Name:
M
Provider Middle Name:
KATHY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCDONALD
Provider Other First Name:
MARY
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1093769150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31493 RANCHO PUEBLO RD, SUITE # 107
Provider Second Line Business Mailing Address:
THE MCDONALD CLINIC, INC.
Provider Business Mailing Address City Name:
TEMECULA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92592
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-303-3337
Provider Business Mailing Address Fax Number:
951-303-2810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31493 RANCHO PUEBLO RD, SUITE # 107
Provider Second Line Business Practice Location Address:
THE MCDONALD CLINIC, INC.
Provider Business Practice Location Address City Name:
TEMECULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-303-3337
Provider Business Practice Location Address Fax Number:
951-303-2810
Provider Enumeration Date:
05/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A93619 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: MD00042460 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 9933 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 9247 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)