Healthcare Provider Details

I. General information

NPI: 1952852808
Provider Name (Legal Business Name): BRITTNEY ROSE BLAIS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2016
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MAIN ST
EL CAJON CA
92020-4007
US

IV. Provider business mailing address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2498
  • Fax:
Mailing address:
  • Phone: 619-515-2300
  • Fax: 619-906-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: