Provider Demographics
NPI:1073158713
Name:MAYER, NAZANEEN
Entity Type:Individual
Prefix:
First Name:NAZANEEN
Middle Name:
Last Name:MAYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 MISSION GORGE RD APT 1447
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2490
Mailing Address - Country:US
Mailing Address - Phone:858-208-6470
Mailing Address - Fax:
Practice Address - Street 1:220 W C ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3804
Practice Address - Country:US
Practice Address - Phone:619-232-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN84327163W00000X
CA95054395163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse