Provider Demographics
NPI:1710702014
Name:KATHMED
Entity type:Organization
Organization Name:KATHMED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TWEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-645-6636
Mailing Address - Street 1:310 S TWIN OAKS VALLEY RD # 107-229
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4303
Mailing Address - Country:US
Mailing Address - Phone:818-645-6366
Mailing Address - Fax:
Practice Address - Street 1:2382 FARADAY AVE STE 200-25
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7218
Practice Address - Country:US
Practice Address - Phone:760-295-8069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty