Basic Information
| Provider Information | |||||||||
| NPI: | 1710549951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAUB | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | NOREEN | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1628 PALOMINO LN | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920256339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608715964 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 VALPREDA RD | ||||||||
| Address2: | |||||||||
| City: | SAN MARCOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920692973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607366780 | ||||||||
| FaxNumber: | 9512965840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2019 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | NP95010566 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.