Healthcare Provider Details

I. General information

NPI: 1710524814
Provider Name (Legal Business Name): MEGAN ORESTANO PMHNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2019
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date: 04/20/2023
Reactivation Date: 09/26/2023

III. Provider practice location address

9845 ERMA RD STE 200
SAN DIEGO CA
92131-1057
US

IV. Provider business mailing address

4103 APPLETON ST
SAN DIEGO CA
92117-1103
US

V. Phone/Fax

Practice location:
  • Phone: 619-937-2055
  • Fax:
Mailing address:
  • Phone: 858-752-8582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039703
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95206038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: