Provider Demographics
NPI:1528173960
Name:KOLLISCH, NANCY RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:RUTH
Last Name:KOLLISCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8008 FROST ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4205
Mailing Address - Country:US
Mailing Address - Phone:858-427-8699
Mailing Address - Fax:619-296-4930
Practice Address - Street 1:8008 FROST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4205
Practice Address - Country:US
Practice Address - Phone:858-427-8699
Practice Address - Fax:619-296-4930
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2013-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG44466207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G444660Medicaid
CAA49659Medicare UPIN
CAG44466Medicare ID - Type Unspecified