Healthcare Provider Details

I. General information

NPI: 1447689609
Provider Name (Legal Business Name): STACEY MARIE NEGRETE PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25485 MEDICAL CENTER DR SUITE 220
MURRIETA CA
92562-6900
US

IV. Provider business mailing address

3860 CALLE FORTUNADA SUITE 200
SAN DIEGO CA
92123-4800
US

V. Phone/Fax

Practice location:
  • Phone: 951-461-9300
  • Fax:
Mailing address:
  • Phone: 858-636-4800
  • Fax: 858-636-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95000089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: