Healthcare Provider Details

I. General information

NPI: 1710184577
Provider Name (Legal Business Name): RITA MARIE HAVERKAMP RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 PARKWAY DR
LA MESA CA
91942-2104
US

IV. Provider business mailing address

8080 PARKWAY DR
LA MESA CA
91942-2104
US

V. Phone/Fax

Practice location:
  • Phone: 619-589-3313
  • Fax: 619-589-3260
Mailing address:
  • Phone: 619-589-3313
  • Fax: 619-589-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: