Healthcare Provider Details

I. General information

NPI: 1629570841
Provider Name (Legal Business Name): MARISELA KUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2018
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 CITRACADO PKWY STE 200
ESCONDIDO CA
92029-4159
US

IV. Provider business mailing address

308 RANCHO DEL ORO DR APT 232
OCEANSIDE CA
92057-7324
US

V. Phone/Fax

Practice location:
  • Phone: 760-290-8170
  • Fax:
Mailing address:
  • Phone: 760-533-2370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: