Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95006840 | CA |
NPI | 1053837187 |
---|---|
Provider Name | Alison Cusmano |
First Address | San Diego, CA 92127-5705 |
Second Address | San Diego, CA 92130-3318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2017 |
Last Update Date | 12/12/2019 |