Healthcare Provider Details

I. General information

NPI: 1760012702
Provider Name (Legal Business Name): DAYNA WASS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 E ALVARADO ST
FALLBROOK CA
92028-2315
US

IV. Provider business mailing address

775 BREEZE HILL RD APT 1135
VISTA CA
92081-4352
US

V. Phone/Fax

Practice location:
  • Phone: 760-509-9509
  • Fax:
Mailing address:
  • Phone: 951-694-2177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012055
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: