Individual
KATHRYN E VON ZUMWALT TISCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15741 VILLA SIERRA RD, VALLEY CENTER, CA 92082-7655
(760) 638-0770
Mailing address
15741 VILLA SIERRA RD, VALLEY CENTER, CA 92082-7655
(760) 638-0770
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M0589436
DRIVER LICENSE
CA
Enumeration date
10/21/2020
Last updated
10/21/2020
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