Healthcare Provider Details

I. General information

NPI: 1346443983
Provider Name (Legal Business Name): THU M HA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6973 LINDA VISTA ROAD
SAN DIEGO CA
92111-6339
US

IV. Provider business mailing address

6973 LINDA VISTA ROAD
SAN DIEGO CA
92111-6339
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-0925
  • Fax: 858-633-4680
Mailing address:
  • Phone: 858-279-9676
  • Fax: 858-279-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number686190
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: