is a Nurse Practitioner in San Diego, California. practices all healthcare services and medical treatments related to Nurse Practitioner. The NPI Number for is 1124079702. The last update date is .
's current location address is 9610 Granite Ridge Dr, San Diego, California. You can contact this provider via phone number 8588108000 and fax number 8582681911. The mailing address for is 9610 Granite Ridge Dr, San Diego, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 9610 Granite Ridge Dr, San Diego, California |
| Phone Number | 8588108000 |
| Fax Number | 8582681911 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1124079702 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 9610 Granite Ridge Dr |
|---|---|
| City | San Diego |
| State | California (CA) |
| Post Code | 921232684 |
| Phone Number | 8588108000 |
| Fax Number | 8582681911 |
Provider's Primary Taxonomy Detail
| Speciality | Nurse Practitioner |
|---|---|
| Taxonomy | 363L00000X |
| Licence No | NP15871 |
|
Definition: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certifi |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| NP15871 | CA | NURSE PRACTITIONER LICENS | |
| EK495Y | CA | SO. CALIFORNIA PTAN |
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