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NPI Code Detail

MEDICARE: NELTADA CHARLEMAGNE PMHNP

MEDICARE: NELTADA CHARLEMAGNE PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner95018515CA

General Provider Information

NPI Number : 1083386437
Entity Type Code : Individual
Provider Name (Legal Business Name) : NELTADA CHARLEMAGNE PMHNP
Provider Business Mailing Address
First Line : 1741 EASTLAKE PKWY
Second Line : STE 102 PMB 1209
City : CHULA VISTA
State : CA
Zip : 91915
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5472 EL CAJON BLVD STE 101
Second Line :
City : SAN DIEGO
State : CA
Zip : 92115-3651
Country : US
Telephone Number : 619-269-0836
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2021
Last Update Date : 06/09/2025

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