Colleen Gustafson Espenschied, PA-C.
Individual provider Active NPI Surgical Physician Assistant · San Diego, CA
NPI 1366464471 · NPPES record last updated Apr 4, 2013
Key facts
- NPI
- 1366464471
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- PA17108 (CA)
- Practice address
- 2017 1St Ave
San Diego, CA 92101-2033 - Phone
- (619) 881-4577
- Fax
- (619) 231-1031
- NPI assigned
- Jul 25, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA17108 | CA | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairfax Radiological Consultants | Past | Accepting new patients | |
| Planned Parenthood of the Pacific Southwest | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA17108 | CA | Yes |
Addresses
Primary practice location
2017 1St Ave
San Diego, CA 92101-2033
Mailing address
File 54433
Los Angeles, CA 90074-0001
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA17108 | Medicaid | CA |
Other names
- Colleen Gustafson
Other providers in San Diego, CA
- Rebecca Azucena Espat
- Christine Norie Espejo
- Emmanuel Peter Espejo
- Jennifer Marleny Espejo
- Marissa Capule Espejo
- Melizza Ramirez Esperanza
- Virginia Esperanza
- Anna Alicia Espericueta
- Jasleen Esmeralda Espindola Melendrez
- Elliana Espino
All providers in San Diego, CA · Surgical Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.