Healthcare Provider Details

I. General information

NPI: 1912825654
Provider Name (Legal Business Name): YURI GUAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

11878 AVENUE OF INDUSTRY
SAN DIEGO CA
92128-3423
US

IV. Provider business mailing address

4847 PARKS AVE APT 13
LA MESA CA
91942-8652
US

V. Phone/Fax

Practice location:
  • Phone: 858-487-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: