Provider Demographics
NPI:1154681153
Name:DUSTIN, CAROLINE MAI ANH (DO)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MAI ANH
Last Name:DUSTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10670 WEXFORD ST # 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3940
Mailing Address - Country:US
Mailing Address - Phone:858-499-2702
Mailing Address - Fax:858-621-4038
Practice Address - Street 1:10670 WEXFORD ST # 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3940
Practice Address - Country:US
Practice Address - Phone:858-499-2702
Practice Address - Fax:858-621-4038
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL0894174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist