Healthcare Provider Details

I. General information

NPI: 1134106362
Provider Name (Legal Business Name): CHRISTENSEN SICAT HSU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTENSEN COSME SICAT DDS

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5256 S MISSION RD STE 1103
BONSALL CA
92003-3624
US

IV. Provider business mailing address

5256 S MISSION RD STE 1103
BONSALL CA
92003-3624
US

V. Phone/Fax

Practice location:
  • Phone: 760-350-2060
  • Fax: 760-350-2064
Mailing address:
  • Phone: 760-350-2060
  • Fax: 760-350-2064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN16248
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number44362
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number44362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: