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NPI Code Detail

MEDICARE: COLLEEN VIRGINIA WORTH FNP

MEDICARE: COLLEEN VIRGINIA WORTH FNP
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
1363LF0000XFamily Nurse PractitionerNP22788CA

General Provider Information

NPI Number : 1285875427
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN VIRGINIA WORTH FNP
Provider Business Mailing Address
First Line : 823 GATEWAY CENTER WAY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-4541
Country : US
Telephone Number : 619-515-2300
Fax Number : 619-906-4623
Provider Business Practice Location Address
First Line : 1250 6TH AVE STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-4368
Country : US
Telephone Number : 619-515-2430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2009
Last Update Date : 03/17/2018

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Directions to “ COLLEEN VIRGINIA WORTH FNP” Practice Location

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