Healthcare Provider Details

I. General information

NPI: 1538705579
Provider Name (Legal Business Name): GUADALUPE ORNELAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GUADALUPE MALDONADO ORNELAS

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9898 GENESEE AVE
LA JOLLA CA
92037-1205
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-824-5115
  • Fax:
Mailing address:
  • Phone: 858-824-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95012706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: