Healthcare Provider Details

I. General information

NPI: 1982979340
Provider Name (Legal Business Name): NADIA BUKAR PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 VISTA HILL AVE
SAN DIEGO CA
92123-2717
US

IV. Provider business mailing address

7850 VISTA HILL AVE
SAN DIEGO CA
92123-2717
US

V. Phone/Fax

Practice location:
  • Phone: 657-522-2893
  • Fax:
Mailing address:
  • Phone: 858-278-4110
  • Fax: 858-278-5920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number754512
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95018344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: