Healthcare Provider Details

I. General information

NPI: 1255267514
Provider Name (Legal Business Name): LINDA UPDEGRAFF PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CARPINTERIA STREET
CHULA VISTA CA
91913
US

IV. Provider business mailing address

1350 CARPINTERIA ST
CHULA VISTA CA
91913-2520
US

V. Phone/Fax

Practice location:
  • Phone: 540-664-3885
  • Fax:
Mailing address:
  • Phone: 540-664-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number95040202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: