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General NPI Number Information
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NPI Number | 1023816501
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Entity Type | Individual
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Provider Name | ENNEMAN IRENE TAD-AWAN NP
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Gender | Female
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 1173 FRONT ST
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City | SAN DIEGO
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State | CA
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Zip | 92101-3904
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Country | US
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Telephone | 619-409-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 683 ASH AVE
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City | CHULA VISTA
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State | CA
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Zip | 91910-5338
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Country | US
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Telephone | 417-860-9671
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95029080
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License Number State | CA
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