Healthcare Provider Details

I. General information

NPI: 1154146876
Provider Name (Legal Business Name): DANIELLE KOBUS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 VISTA WAY
OCEANSIDE CA
92056-4500
US

IV. Provider business mailing address

3631 VIA BERNARDO
OCEANSIDE CA
92056-7225
US

V. Phone/Fax

Practice location:
  • Phone: 760-630-4678
  • Fax:
Mailing address:
  • Phone: 413-822-5136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number794834
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: