Provider Demographics
NPI:1972644482
Name:KRUSE, TORSTEN J (MD)
Entity type:Individual
Prefix:
First Name:TORSTEN
Middle Name:J
Last Name:KRUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 VIA SUERTE
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6531
Mailing Address - Country:US
Mailing Address - Phone:949-364-5600
Mailing Address - Fax:
Practice Address - Street 1:831 VIA SUERTE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6531
Practice Address - Country:US
Practice Address - Phone:949-364-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75928207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFS827ZMedicare PIN
CAH67246Medicare UPIN