Healthcare Provider Details

I. General information

NPI: 1497661623
Provider Name (Legal Business Name): BRIANNA NICHOLE TURSELLINO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9655 GRANITE RIDGE DR STE 200
SAN DIEGO CA
92123-2676
US

IV. Provider business mailing address

9655 GRANITE RIDGE DR STE 200
SAN DIEGO CA
92123-2676
US

V. Phone/Fax

Practice location:
  • Phone: 619-604-3121
  • Fax: 619-604-3138
Mailing address:
  • Phone: 619-604-3121
  • Fax: 619-604-3138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA68806
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: