Healthcare Provider Details

I. General information

NPI: 1215451117
Provider Name (Legal Business Name): DEVIN ANDERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEVIN K DIETRICH

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 MISSION AVE
OCEANSIDE CA
92057-6541
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 760-901-5010
  • Fax:
Mailing address:
  • Phone: 760-901-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: