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General NPI Number Information
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NPI Number | 1154516243
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Entity Type | Organization
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Legal Business Name | SUSAN KAWESKI, M.D. A PROFESSIONAL
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 06/11/2009
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Provider Practice Location Address
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Address Line | 8415 GRANT AVE
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City | LA MESA
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State | CA
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Zip | 91941-5303
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Country | US
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Telephone | 619-464-9876
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Fax | 619-464-9877
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Provider Business Mailing Address
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Address Line | 8415 GRANT AVE.
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City | LA MESA
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State | CA
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Zip | 91941
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Country | US
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Telephone | 619-464-9876
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Fax | 619-464-9877
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN KAWESKI
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Credential | M.D.
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Telephone | 619-464-9876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G53909
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License Number State | CA
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