Healthcare Provider Details

I. General information

NPI: 1679602619
Provider Name (Legal Business Name): SCOTT E MUSINSKI, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 W CANYON AVE
SAN DIEGO CA
92123-5428
US

IV. Provider business mailing address

3160 W CANYON AVE
SAN DIEGO CA
92123-5428
US

V. Phone/Fax

Practice location:
  • Phone: 760-583-0924
  • Fax: 844-352-6658
Mailing address:
  • Phone: 760-583-0924
  • Fax: 844-352-6658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SCOTT E MUSINSKI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-583-0924