Healthcare Provider Details

I. General information

NPI: 1487935524
Provider Name (Legal Business Name): DENISE MARIE KRUSZEWSKI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4491 BRISBANE WAY UNIT 2
OCEANSIDE CA
92058-0647
US

IV. Provider business mailing address

4491 BRISBANE WAY UNIT 2
OCEANSIDE CA
92058-0647
US

V. Phone/Fax

Practice location:
  • Phone: 480-266-4265
  • Fax:
Mailing address:
  • Phone: 480-266-4265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number24375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: