Healthcare Provider Details

I. General information

NPI: 1912860438
Provider Name (Legal Business Name): SUSAN BARNDOLLAR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 NORMAL ST RM 2121
SAN DIEGO CA
92103-2653
US

IV. Provider business mailing address

4100 NORMAL ST RM 2121
SAN DIEGO CA
92103-2653
US

V. Phone/Fax

Practice location:
  • Phone: 619-725-5501
  • Fax: 619-725-8073
Mailing address:
  • Phone: 619-725-5501
  • Fax: 619-725-8073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number429237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: