Healthcare Provider Details

I. General information

NPI: 1205625001
Provider Name (Legal Business Name): STEPHANIE ALEXANDER BUHOLZER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4142 ADAMS AVE
SAN DIEGO CA
92116-2592
US

IV. Provider business mailing address

4142 ADAMS AVE
SAN DIEGO CA
92116-2592
US

V. Phone/Fax

Practice location:
  • Phone: 858-617-0717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95030315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: