MEDICARE: JANELLE BIRD DR

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
1	363LG0600X	Gerontology Nurse Practitioner	95018247	CA

General Provider Information

NPI Number	:	1447915830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANELLE BIRD DR

Provider Business Mailing Address
First Line	:	2006 REDBIRD DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-3726
Country	:	US
Telephone Number	:	858-776-0771
Fax Number	:

Provider Business Practice Location Address
First Line	:	2006 REDBIRD DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-3726
Country	:	US
Telephone Number	:	858-776-0771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	06/28/2023

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