Healthcare Provider Details

I. General information

NPI: 1114524402
Provider Name (Legal Business Name): MA ROSA NIKA Z VARRIN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3591 RUFFIN RD UNIT 126
SAN DIEGO CA
92123-2557
US

IV. Provider business mailing address

3591 RUFFIN RD UNIT 126
SAN DIEGO CA
92123-2557
US

V. Phone/Fax

Practice location:
  • Phone: 858-642-5026
  • Fax:
Mailing address:
  • Phone: 858-642-5026
  • Fax: 619-330-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95185524
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95029156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: