Healthcare Provider Details

I. General information

NPI: 1235696154
Provider Name (Legal Business Name): ANNA MARIE BISHOP PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 30TH ST STE K
SAN DIEGO CA
92154-3497
US

IV. Provider business mailing address

1465 30TH ST STE K
SAN DIEGO CA
92154-3497
US

V. Phone/Fax

Practice location:
  • Phone: 619-428-1000
  • Fax: 619-428-1091
Mailing address:
  • Phone: 619-428-1000
  • Fax: 619-428-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95457349
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: