Healthcare Provider Details

I. General information

NPI: 1023130606
Provider Name (Legal Business Name): JANET ROBERTA MACAULEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 FROST ST
SAN DIEGO CA
92123-2701
US

IV. Provider business mailing address

8959 CHESTNUT ROAN WAY
ALPINE CA
91901-2786
US

V. Phone/Fax

Practice location:
  • Phone: 858-939-4624
  • Fax: 858-939-4627
Mailing address:
  • Phone: 619-659-0089
  • Fax: 619-659-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number371946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: