Healthcare Provider Details

I. General information

NPI: 1700704152
Provider Name (Legal Business Name): COURTNEY SIERRA DUNTSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 JEFFERSON ST
SAN DIEGO CA
92110-4421
US

IV. Provider business mailing address

3295 C ST APT 220
SAN DIEGO CA
92102-2493
US

V. Phone/Fax

Practice location:
  • Phone: 619-683-3100
  • Fax:
Mailing address:
  • Phone: 619-957-5494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: