Healthcare Provider Details

I. General information

NPI: 1548021512
Provider Name (Legal Business Name): PERI KUMIKO TRESSLAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PERI KUMIKO KNOBBE

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6719 ALVARADO RD STE 303
SAN DIEGO CA
92120-5264
US

IV. Provider business mailing address

4827 ELSA RD
SAN DIEGO CA
92120-4210
US

V. Phone/Fax

Practice location:
  • Phone: 619-500-7699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95028824
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95172020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: