Healthcare Provider Details

I. General information

NPI: 1629327259
Provider Name (Legal Business Name): CHRISTINE P MATHEWS DNP, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DR.
SAN DIEGO CA
92161
US

IV. Provider business mailing address

3350 LA JOLLA VILLAGE DR.
SAN DIEGO CA
92161
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8585
  • Fax:
Mailing address:
  • Phone: 858-552-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number22044
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number22044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: