Healthcare Provider Details

I. General information

NPI: 1194972950
Provider Name (Legal Business Name): JUDITH ANN GASPAR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2008
Last Update Date: 08/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR DEPT 39
LA JOLLA CA
92093-0039
US

IV. Provider business mailing address

13655 WINSTANLEY WAY
SAN DIEGO CA
92130-1412
US

V. Phone/Fax

Practice location:
  • Phone: 858-822-4758
  • Fax: 858-534-0814
Mailing address:
  • Phone: 858-481-0845
  • Fax: 858-793-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: