Provider Demographics
NPI:1477808137
Name:KURNIADI, NATALIE ELVITA (PHD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:ELVITA
Last Name:KURNIADI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9968 HIBERT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1036
Mailing Address - Country:US
Mailing Address - Phone:858-693-3113
Mailing Address - Fax:858-312-8460
Practice Address - Street 1:9968 HIBERT ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1036
Practice Address - Country:US
Practice Address - Phone:858-693-3113
Practice Address - Fax:858-312-8460
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32552103G00000X
CAPSY32552103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist