Healthcare Provider Details

I. General information

NPI: 1831858125
Provider Name (Legal Business Name): HEATHER LEIGH HOBSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 CAMINO DEL RIO N
SAN DIEGO CA
92108-1633
US

IV. Provider business mailing address

1679 DIAMOND ST
SAN DIEGO CA
92109-3174
US

V. Phone/Fax

Practice location:
  • Phone: 866-284-8788
  • Fax:
Mailing address:
  • Phone: 443-567-9617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95076967
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95019302
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95019302
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95019302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: