Healthcare Provider Details

I. General information

NPI: 1134559016
Provider Name (Legal Business Name): SPRING MARIE DEGOMEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 06/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10717 CAMINO RUIZ STE 258
SAN DIEGO CA
92126-2364
US

IV. Provider business mailing address

1075 CAMINO DEL RIO S
SAN DIEGO CA
92108-3538
US

V. Phone/Fax

Practice location:
  • Phone: 619-881-4564
  • Fax:
Mailing address:
  • Phone: 619-881-4500
  • Fax: 619-291-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95000629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: