Healthcare Provider Details

I. General information

NPI: 1508772369
Provider Name (Legal Business Name): KAITLYN VICTORIA MUDGE DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 HALE PL STE 110
CHULA VISTA CA
91914-3598
US

IV. Provider business mailing address

536 VIA DE LA VALLE UNIT A
SOLANA BEACH CA
92075-2484
US

V. Phone/Fax

Practice location:
  • Phone: 619-704-7577
  • Fax:
Mailing address:
  • Phone: 619-704-7577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95040593
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: