Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 50105 | CA |
NPI | 1003171273 |
---|---|
Provider Name | Mrs. Katherine Anita Thomson |
First Address | La Jolla, CA 92037-1714 |
Second Address | La Jolla, CA 92037-1714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2012 |
Last Update Date | 17/05/2016 |