Healthcare Provider Details

I. General information

NPI: 1407347065
Provider Name (Legal Business Name): ANAHITA KEMP FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4765 CARMEL MOUNTAIN RD STE 103
SAN DIEGO CA
92130-6657
US

IV. Provider business mailing address

4765 CARMEL MOUNTAIN RD STE 103
SAN DIEGO CA
92130-6657
US

V. Phone/Fax

Practice location:
  • Phone: 619-461-1500
  • Fax:
Mailing address:
  • Phone: 619-461-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008345
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number798764
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: