Provider Demographics
NPI:1225754930
Name:KRUGER, NAOMI SALVATIERRA (RN-BC)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:SALVATIERRA
Last Name:KRUGER
Suffix:
Gender:F
Credentials:RN-BC
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:MANALO
Other - Last Name:SALVATIERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12549 EL CAMINO REAL UNIT A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4056
Mailing Address - Country:US
Mailing Address - Phone:603-978-0906
Mailing Address - Fax:
Practice Address - Street 1:1250 MORENA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3815
Practice Address - Country:US
Practice Address - Phone:603-978-0906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95278400163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health