Healthcare Provider Details

I. General information

NPI: 1780757823
Provider Name (Legal Business Name): CAROLE JOY RICHARDS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 FROST ST SUITE 414
SAN DIEGO CA
92123-2778
US

IV. Provider business mailing address

1441 E 17TH ST
NATIONAL CITY CA
91950-5018
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-7711
  • Fax: 858-966-7712
Mailing address:
  • Phone: 619-477-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number10775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: