Provider Demographics
NPI:1861747545
Name:SUNDSMO, CATHERINE LOUISE (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LOUISE
Last Name:SUNDSMO
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 1:821 EAST 18TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4797
Mailing Address - Country:US
Mailing Address - Phone:307-632-2434
Mailing Address - Fax:307-634-3510
Practice Address - Street 1:2600 VIA DE LA VALLE
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-1992
Practice Address - Country:US
Practice Address - Phone:858-499-2708
Practice Address - Fax:858-309-3269
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY9712A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine