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General NPI Number Information
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NPI Number | 1336758085
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Entity Type | Individual
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Provider Name | DANIEL KRUSE
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Gender | Male
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Dates
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Enumeration Date | 07/29/2020
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 5472 EL CAJON BLVD STE 101
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City | SAN DIEGO
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State | CA
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Zip | 92115-3651
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Country | US
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Telephone | 619-269-0836
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Fax | 619-269-0906
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Provider Business Mailing Address
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Address Line | 4867 LOUKELTON WAY
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City | SAN DIEGO
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State | CA
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Zip | 92120-3631
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Country | US
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Telephone | 760-964-7581
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 104748
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 126330
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License Number State | CA
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