Individual ProviderNicole DusterPediatricsAllopathic & Osteopathic PhysiciansPractice Address3020 Children'S Way, Mc 5124, San Diego, CA 92123(858) 966-6764PECOS EnrollmentBased on the most recent information from CMS, provider Nicole Duster does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 2:29 PM.Profile DetailsProvider ID1477116614Provider TypeIndividualFull NameDuster, NicoleTitleDr.CredentialMDGenderFemaleSole ProprietorNoEnumeration Date4/14/2019Last Updated6/17/2022Contact InformationPractice LocationPractice Address3020 Children'S Way, Mc 5124, San Diego, CA 92123Phone(858) 966-6764FaxUnlisted FaxMailing LocationMailing Address3020 Children'S Way, Mc 5124, San Diego, CA 92123Phone(858) 966-6764FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode208000000XPrimaryDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicensePTL1358CaliforniaCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer