Healthcare Provider Details

I. General information

NPI: 1033545447
Provider Name (Legal Business Name): JENNIFER YU PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 10/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 LINDA VISTA RD
SAN DIEGO CA
92111-6307
US

IV. Provider business mailing address

6973 LINDA VISTA RD
SAN DIEGO CA
92111-6342
US

V. Phone/Fax

Practice location:
  • Phone: 858-810-8787
  • Fax: 858-981-5825
Mailing address:
  • Phone: 858-279-9676
  • Fax: 858-279-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95004445
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0991778
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95004445
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95090134
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number181181
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: