Healthcare Provider Details

I. General information

NPI: 1295921864
Provider Name (Legal Business Name): MONICA WURSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 01/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18263 SUN MAIDEN CT
SAN DIEGO CA
92127-3103
US

IV. Provider business mailing address

18263 SUN MAIDEN CT
SAN DIEGO CA
92127-3103
US

V. Phone/Fax

Practice location:
  • Phone: 858-673-4726
  • Fax:
Mailing address:
  • Phone: 858-673-4726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number17707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: