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General NPI Number Information
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NPI Number | 1730240052
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Entity Type | Individual
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Provider Name | SHEIVA LENORE POUSTI O.D.
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 3560 FAIRMOUNT AVE
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City | SAN DIEGO
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State | CA
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Zip | 92105-3420
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Country | US
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Telephone | 619-431-2020
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Fax | 619-376-2100
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Provider Business Mailing Address
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Address Line | 7514 GIRARD AVE STE 1231
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City | LA JOLLA
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State | CA
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Zip | 92037-5149
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Country | US
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Telephone | 858-504-2020
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 104030T
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License Number State | CA
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