Healthcare Provider Details

I. General information

NPI: 1831894997
Provider Name (Legal Business Name): ANTONIA EMILIA WUSCHNER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 HEALTH SCIENCES DR
LA JOLLA CA
92093-1503
US

IV. Provider business mailing address

4817 SHEBOYGAN AVE APT 813
MADISON WI
53705-2924
US

V. Phone/Fax

Practice location:
  • Phone: 860-751-8968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: