Healthcare Provider Details

I. General information

NPI: 1710584008
Provider Name (Legal Business Name): VENESSA BECK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 CARDIFF ST
SAN DIEGO CA
92114-5019
US

IV. Provider business mailing address

903 CARDIFF ST
SAN DIEGO CA
92114-5019
US

V. Phone/Fax

Practice location:
  • Phone: 619-465-3121
  • Fax: 619-465-6708
Mailing address:
  • Phone: 619-465-3121
  • Fax: 619-465-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95015282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: