Healthcare Provider Details

I. General information

NPI: 1073241618
Provider Name (Legal Business Name): NATHALIE LIJENZKA CHOI NP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATHALIE LIJENZKA BROOKES

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

V. Phone/Fax

Practice location:
  • Phone: 800-926-8273
  • Fax:
Mailing address:
  • Phone: 619-515-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95022088
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: