Healthcare Provider Details

I. General information

NPI: 1124715784
Provider Name (Legal Business Name): CATHERINE ARCEO KUEHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE ARCEO KUEHN

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1854 CORONADO AVE
SAN DIEGO CA
92154-2007
US

IV. Provider business mailing address

1854 CORONADO AVE
SAN DIEGO CA
92154-2007
US

V. Phone/Fax

Practice location:
  • Phone: 619-424-8612
  • Fax: 619-424-6331
Mailing address:
  • Phone: 619-424-8612
  • Fax: 619-424-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number75613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: