Provider Demographics
NPI:1063731297
Name:TUSTISON, KIMBERLY (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:TUSTISON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21634 RETREAT PKWY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-6100
Mailing Address - Country:US
Mailing Address - Phone:951-493-6814
Mailing Address - Fax:951-826-8134
Practice Address - Street 1:21634 RETREAT PKWY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-6100
Practice Address - Country:US
Practice Address - Phone:951-493-6814
Practice Address - Fax:951-826-8134
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA131535207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology