Healthcare Provider Details

I. General information

NPI: 1093086530
Provider Name (Legal Business Name): NICOLE MARIE KUSHCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE MARIE STEINBERG

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6030 SANTO RD SUITE C
SAN DIEGO CA
92124-1196
US

IV. Provider business mailing address

6030 SANTO RD SUITE C
SAN DIEGO CA
92124-1196
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-0200
  • Fax: 858-499-0224
Mailing address:
  • Phone: 858-499-0200
  • Fax: 858-499-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA 7703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: