Healthcare Provider Details

I. General information

NPI: 1215121850
Provider Name (Legal Business Name): NANCY BABARAN MOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY GUIAB JEFFERIES NP

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 EL CAMINO REAL STE 317
SAN DIEGO CA
92130-3085
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-794-1250
  • Fax:
Mailing address:
  • Phone: 858-794-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: