Healthcare Provider Details

I. General information

NPI: 1720593098
Provider Name (Legal Business Name): MARK KOESTER RMSK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6699 ALVARADO RD STE 2302
SAN DIEGO CA
92120-5241
US

IV. Provider business mailing address

PO BOX 80218
RANCHO SANTA MARGARITA CA
92688-0218
US

V. Phone/Fax

Practice location:
  • Phone: 949-313-7736
  • Fax: 949-313-7737
Mailing address:
  • Phone: 949-313-7736
  • Fax: 949-313-7737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number146834
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: