Healthcare Provider Details

I. General information

NPI: 1780395897
Provider Name (Legal Business Name): HELEN A. BACZKOWSKI AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16466 BERNARDO CENTER DR STE 150
SAN DIEGO CA
92128-2522
US

IV. Provider business mailing address

PO BOX 910044
SAN DIEGO CA
92191-0044
US

V. Phone/Fax

Practice location:
  • Phone: 858-571-3630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95021259
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95021259
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95021259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: