Provider Demographics
NPI:1053367755
Name:MAYWOOD, CATHERINE (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:MAYWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 NAUTILUS ST
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5636
Mailing Address - Country:US
Mailing Address - Phone:619-579-8681
Mailing Address - Fax:619-579-0678
Practice Address - Street 1:1685 E MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5225
Practice Address - Country:US
Practice Address - Phone:619-579-8681
Practice Address - Fax:619-579-0678
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G68830Medicare ID - Type Unspecified
CAF98747Medicare UPIN