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NPI Code Detail

MEDICARE: KRYSTAL LOUISE HOGE NP

MEDICARE: KRYSTAL LOUISE HOGE NP
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
1363LP0200XPediatric Nurse Practitioner18223CA

General Provider Information

NPI Number : 1508110339
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTAL LOUISE HOGE NP
Provider Business Mailing Address
First Line : 4902 MOUNT ALIFAN DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-2512
Country : US
Telephone Number : 858-444-7402
Fax Number :
Provider Business Practice Location Address
First Line : 34800 BOB WILSON DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92134-1098
Country : US
Telephone Number : 619-532-6250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2012
Last Update Date : 03/26/2026

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