MEDICARE: IAN ALEXANDER BUCKLAND 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
1	363LF0000X	Family Nurse Practitioner	95018502	CA

General Provider Information

NPI Number	:	1700546132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN ALEXANDER BUCKLAND FNP

Provider Business Mailing Address
First Line	:	1885 DIAMOND ST UNIT 2-321
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3349
Country	:	US
Telephone Number	:	951-239-2845
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 CLAYDELLE AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-4505
Country	:	US
Telephone Number	:	858-717-5029
Fax Number	:

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

Provider Enumeration Date	:	12/27/2021
Last Update Date	:	09/29/2025

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