Healthcare Provider Details

I. General information

NPI: 1790952844
Provider Name (Legal Business Name): SUZANNE KHAMBATA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 MESA COLLEGE DR # L-504
SAN DIEGO CA
92111-4902
US

IV. Provider business mailing address

7250 MESA COLLEGE DR # L-504
SAN DIEGO CA
92111-4902
US

V. Phone/Fax

Practice location:
  • Phone: 619-388-2774
  • Fax: 619-388-2853
Mailing address:
  • Phone: 619-388-2774
  • Fax: 619-388-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number8165
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: