Provider Demographics
NPI:1760826705
Name:MISHEK, DEBORAH G (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:G
Last Name:MISHEK
Suffix:
Gender:F
Credentials:MD
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 420538
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92142-0538
Mailing Address - Country:US
Mailing Address - Phone:858-581-5053
Mailing Address - Fax:858-279-4312
Practice Address - Street 1:12625 HIGH BLUFF DR
Practice Address - Street 2:SUITE 302
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2052
Practice Address - Country:US
Practice Address - Phone:858-581-5053
Practice Address - Fax:858-279-4312
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG664132080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics