Healthcare Provider Details

I. General information

NPI: 1295231371
Provider Name (Legal Business Name): KAREN ANN HVIZDZAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN ANN MACKALL NP

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8875 AERO DR
SAN DIEGO CA
92123-2251
US

IV. Provider business mailing address

8775 AERO DR
SAN DIEGO CA
92123-1792
US

V. Phone/Fax

Practice location:
  • Phone: 619-400-5050
  • Fax: 619-400-5055
Mailing address:
  • Phone: 619-400-5050
  • Fax: 619-400-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: