Healthcare Provider Details

I. General information

NPI: 1033076336
Provider Name (Legal Business Name): ILEANNA DIGIACINTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4337 VALLE VIS
SAN DIEGO CA
92103-1254
US

IV. Provider business mailing address

4337 VALLE VIS
SAN DIEGO CA
92103-1254
US

V. Phone/Fax

Practice location:
  • Phone: 619-972-8602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026054207
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number644282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: