Provider Demographics
NPI:1790056539
Name:MUSSER, ELENA T
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:T
Last Name:MUSSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WEST ARBOR DRIVE
Mailing Address - Street 2:MC # 8897
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8897
Mailing Address - Country:US
Mailing Address - Phone:619-543-2628
Mailing Address - Fax:619-543-6573
Practice Address - Street 1:200 WEST ARBOR DRIVE
Practice Address - Street 2:MC # 8897
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8897
Practice Address - Country:US
Practice Address - Phone:619-543-2628
Practice Address - Fax:619-543-6573
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1056803133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered