Healthcare Provider Details

I. General information

NPI: 1134635683
Provider Name (Legal Business Name): MRS. KHEYRSTEN SEUFERER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KHEYRSTEN MAASCH MAIDEN NAME

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3978 SORRENTO VALLEY BLVD STE 100
SAN DIEGO CA
92121-1436
US

IV. Provider business mailing address

15105 OLDE HIGHWAY 80 SPC 11
EL CAJON CA
92021-2404
US

V. Phone/Fax

Practice location:
  • Phone: 858-353-7723
  • Fax:
Mailing address:
  • Phone: 503-949-1628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: