Healthcare Provider Details

I. General information

NPI: 1437880721
Provider Name (Legal Business Name): VINCENT DAVID FEITOSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2022
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 CALAVO DR
LA MESA CA
91941-7052
US

IV. Provider business mailing address

1050 UNIVERSITY AVE STE E107
SAN DIEGO CA
92103-3359
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-9060
  • Fax: 234-217-5578
Mailing address:
  • Phone: 858-848-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95014252
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number24194692
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number242041
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95014252
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number554434
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number238374
License Number StateAK
# 7
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1341288
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95129842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: