Provider Demographics
NPI:1023221074
Name:KIRSCH, CHRISTINE L (AUD, FAAA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 CAMPANILE DR
Mailing Address - Street 2:SAN DIEGO
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92182-1518
Mailing Address - Country:US
Mailing Address - Phone:619-594-7747
Mailing Address - Fax:619-594-5917
Practice Address - Street 1:5500 CAMPANILE DR
Practice Address - Street 2:SAN DIEGO
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92182-1518
Practice Address - Country:US
Practice Address - Phone:619-594-7747
Practice Address - Fax:619-594-5917
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2031231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU 2031OtherAUDIOLOGY LICENSE
CAHA 4142OtherDISPENSER LICENSE