MEDICARE: DR. KRISTIN ZEISING PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY19164	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11477705	OTHER	CA	CAQH ID

General Provider Information

NPI Number	:	1720091069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIN ZEISING PSY.D.

Provider Business Mailing Address
First Line	:	12625 HIGH BLUFF DR
Second Line	:	STE 104
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2054
Country	:	US
Telephone Number	:	858-414-0097
Fax Number	:	858-793-1124

Provider Business Practice Location Address
First Line	:	12625 HIGH BLUFF DR STE 104
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2053
Country	:	US
Telephone Number	:	858-414-0097
Fax Number	:	858-793-1124

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	04/08/2010

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