Healthcare Provider Details

I. General information

NPI: 1780334110
Provider Name (Legal Business Name): ZINNIA AMARESH KIDANE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6973 LINDA VISTA RD
SAN DIEGO CA
92111-6342
US

IV. Provider business mailing address

6973 LINDA VISTA RD
SAN DIEGO CA
92111-6342
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-9676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95026032
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95168866
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: