Provider Demographics
NPI:1588229926
Name:KUSIAK, ELISABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:KUSIAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82923
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92138-2923
Mailing Address - Country:US
Mailing Address - Phone:423-314-1230
Mailing Address - Fax:
Practice Address - Street 1:4501 MISSION BAY DR # 1C&D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4923
Practice Address - Country:US
Practice Address - Phone:423-314-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical