Healthcare Provider Details

I. General information

NPI: 1104485580
Provider Name (Legal Business Name): SOJOURNER LYNN BIXLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39765 DATE ST
MURRIETA CA
92563-2005
US

IV. Provider business mailing address

39765 DATE ST
MURRIETA CA
92563-2005
US

V. Phone/Fax

Practice location:
  • Phone: 951-894-4665
  • Fax: 951-894-5178
Mailing address:
  • Phone: 951-894-4665
  • Fax: 951-894-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP140783
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95017491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: