Provider Demographics
NPI:1417984949
Name:KAUSHIK, RENU VISHWANATH (MD)
Entity Type:Individual
Prefix:
First Name:RENU
Middle Name:VISHWANATH
Last Name:KAUSHIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2901 MEADOWLARK DRIVE
Mailing Address - Street 2:MSP535
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-694-4752
Mailing Address - Fax:858-514-8425
Practice Address - Street 1:2801 MEADOWLARK DRIVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-694-4752
Practice Address - Fax:858-514-8425
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA671952084P0804X
NV94732084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry