Provider Demographics
NPI:1467158857
Name:SOLANO, AUDREY MALBOG (FNP-BC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:MALBOG
Last Name:SOLANO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8675 LYNX RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1828
Mailing Address - Country:US
Mailing Address - Phone:714-747-6672
Mailing Address - Fax:
Practice Address - Street 1:655 EUCLID AVE STE 205
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2967
Practice Address - Country:US
Practice Address - Phone:619-470-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner