Active NPI
Katrina E Woodhall, M.D.
- Dermatology Physician
- San Diego, CA
National Provider Identifier
1639104383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- A89622
- Practice address
- 501 Washington St Ste 502
San Diego, CA 92103-2238 - Phone
- (619) 542-0013
- Fax
- (858) 257-1648
- NPI assigned
- Jul 11, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | A89622 | CA | Primary |
Addresses
Primary practice location
501 Washington St Ste 502
San Diego, CA 92103-2238
Mailing address
31915 Rancho California Rd
Ste 200216
Temecula, CA 92591-5132
Phone (858) 401-2738
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00611073 | Other | CA | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 89622 | CA | MD | Marriage & Family Therapist |
| A89622 | CA | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bradley Mudge MD Inc | Past | Accepting new patients | |
| Stacy D. Tompkins, M.D., Inc. | Dermatology | Past | Accepting new patients |
| Dignity Health Medical Foundation | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609286400000",
"number": "1639104383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31915 RANCHO CALIFORNIA RD",
"address_2": "STE 200216",
"city": "TEMECULA",
"state": "CA",
"postal_code": "925915132",
"telephone_number": "858-401-2738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 WASHINGTON ST STE 502",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921032238",
"telephone_number": "619-542-0013",
"fax_number": "858-257-1648"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODHALL",
"first_name": "KATRINA",
"middle_name": "E",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-11",
"last_updated": "2020-12-30",
"certification_date": "2020-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "CA",
"license": "A89622",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00611073",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.