Healthcare Provider Details

I. General information

NPI: 1821104126
Provider Name (Legal Business Name): KATHARINE HELEN TZACHANIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHARINE HELEN CONWAY

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 858-822-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP 22542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: