Healthcare Provider Details

I. General information

NPI: 1306185293
Provider Name (Legal Business Name): KALLE ELLEN LUNDEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 619-855-6444
  • Fax:
Mailing address:
  • Phone: 619-855-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number22592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: