Healthcare Provider Details

I. General information

NPI: 1497345946
Provider Name (Legal Business Name): TIMOTHY SARTORI FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 03/17/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

IV. Provider business mailing address

6977 NAVAJO RD # 403
SAN DIEGO CA
92119-1503
US

V. Phone/Fax

Practice location:
  • Phone: 619-704-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015945
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95015945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: