Healthcare Provider Details

I. General information

NPI: 1255116299
Provider Name (Legal Business Name): BRITTNEY CAVACO PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTNEY LOVE

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 RESERVOIR DR STE 309
SAN DIEGO CA
92120-5193
US

IV. Provider business mailing address

1146 GAYWOOD ST
SAN DIEGO CA
92154-1909
US

V. Phone/Fax

Practice location:
  • Phone: 888-963-9639
  • Fax:
Mailing address:
  • Phone: 619-213-3341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95029048
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95184770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: