Healthcare Provider Details

I. General information

NPI: 1588873608
Provider Name (Legal Business Name): RENEE HAAS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 VISTA WAY STE C202
OCEANSIDE CA
92056-4518
US

IV. Provider business mailing address

3998 VISTA WAY STE C202
OCEANSIDE CA
92056-4518
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-1220
  • Fax: 760-758-9735
Mailing address:
  • Phone: 760-758-1220
  • Fax: 760-758-9735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number278747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: