Healthcare Provider Details

I. General information

NPI: 1790053791
Provider Name (Legal Business Name): BRENDA LYNN KING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 B ST STE 1570
SAN DIEGO CA
92101-4560
US

IV. Provider business mailing address

600 B ST STE 1570
SAN DIEGO CA
92101-4560
US

V. Phone/Fax

Practice location:
  • Phone: 619-615-0439
  • Fax: 619-615-3197
Mailing address:
  • Phone: 619-615-0439
  • Fax: 619-615-3197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number516338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: