Healthcare Provider Details

I. General information

NPI: 1295073815
Provider Name (Legal Business Name): NICOLE R. WRITER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE BUDJENSKA PA-C

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 320
LA JOLLA CA
92037-1208
US

IV. Provider business mailing address

6971 EL CAMINO REAL STE 101
CARLSBAD CA
92009-4114
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-1212
  • Fax: 858-795-1195
Mailing address:
  • Phone: 760-603-3221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9107158
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60671158
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: