Healthcare Provider Details

I. General information

NPI: 1497819452
Provider Name (Legal Business Name): NOELLE LEIGH VEJTASA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16899 W BERNARDO DR
SAN DIEGO CA
92127-1603
US

IV. Provider business mailing address

16899 W BERNARDO DR
SAN DIEGO CA
92127-1603
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2702
  • Fax: 858-521-2031
Mailing address:
  • Phone: 858-499-2702
  • Fax: 858-521-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number18900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: