Healthcare Provider Details

I. General information

NPI: 1750041687
Provider Name (Legal Business Name): KESLEY SHAFER AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KESLEY ARHART

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 N TORREY PINES RD
LA JOLLA CA
92037-1035
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-6971
  • Fax:
Mailing address:
  • Phone: 858-554-8998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: