Healthcare Provider Details

I. General information

NPI: 1255868873
Provider Name (Legal Business Name): PATRICIA VLASIN, N.P., INC., A NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2017
Last Update Date: 05/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13754 BASSMORE DR
SAN DIEGO CA
92129-3220
US

IV. Provider business mailing address

9921 CARMEL MTN RD #430
SAN DIEGO CA
92129-2813
US

V. Phone/Fax

Practice location:
  • Phone: 619-602-6351
  • Fax: 858-901-4873
Mailing address:
  • Phone: 619-602-6351
  • Fax: 858-901-4873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP9662
License Number StateCA

VIII. Authorized Official

Name: PATRICIA VLASIN
Title or Position: CHAIRMAN
Credential: NP
Phone: 619-602-6351