Healthcare Provider Details

I. General information

NPI: 1780187435
Provider Name (Legal Business Name): SHEILLA MARIE SAN JOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8778 CUYAMACA ST
SANTEE CA
92071-4255
US

IV. Provider business mailing address

1954 MARQUIS CT
CHULA VISTA CA
91913-3127
US

V. Phone/Fax

Practice location:
  • Phone: 619-449-5555
  • Fax:
Mailing address:
  • Phone: 661-330-0336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number509642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: