=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851412373
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMSALE DENBELA FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 07/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3811 VALLEY CENTRE DR # S99
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92130-3318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-554-7439
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10790 RANCHO BERNARDO RD MAIL DROP 4S-205
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92127-5705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-605-7171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 15376
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------