Provider Demographics
NPI:1831968627
Name:EASTMAN NUSBAUM, DARCY
Entity type:Individual
Prefix:
First Name:DARCY
Middle Name:
Last Name:EASTMAN NUSBAUM
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 1:1426 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-1809
Mailing Address - Country:US
Mailing Address - Phone:805-550-1612
Mailing Address - Fax:
Practice Address - Street 1:2945 MCMILLAN AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6766
Practice Address - Country:US
Practice Address - Phone:805-550-1612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist