Healthcare Provider Details

I. General information

NPI: 1588671069
Provider Name (Legal Business Name): MARY E JOSWIG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CEDAR RD # 200
VISTA CA
92083-5102
US

IV. Provider business mailing address

2201 MISSION AVE
OCEANSIDE CA
92054-2328
US

V. Phone/Fax

Practice location:
  • Phone: 760-806-5540
  • Fax: 760-945-4917
Mailing address:
  • Phone: 760-806-5540
  • Fax: 760-945-4917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5915
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN267491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: