Provider Demographics
NPI:1639753262
Name:KAUFMAN, SHAULA CARBAJAL
Entity Type:Individual
Prefix:
First Name:SHAULA
Middle Name:CARBAJAL
Last Name:KAUFMAN
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 1:2810 CAMINO DEL RIO S STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3819
Mailing Address - Country:US
Mailing Address - Phone:619-299-1419
Mailing Address - Fax:858-461-6008
Practice Address - Street 1:2810 CAMINO DEL RIO S STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3819
Practice Address - Country:US
Practice Address - Phone:619-299-1419
Practice Address - Fax:858-461-6008
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017261363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner