Provider Demographics
NPI:1760139026
Name:ROGERS, CHANDRA FAITH (PMHNP)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:FAITH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2382 FARADAY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7219
Mailing Address - Country:US
Mailing Address - Phone:858-209-9871
Mailing Address - Fax:858-939-1595
Practice Address - Street 1:2382 FARADAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7219
Practice Address - Country:US
Practice Address - Phone:582-099-8718
Practice Address - Fax:858-939-1595
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027329363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health