Provider Demographics
NPI:1760605588
Name:AKERSTEIN, MARY (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:AKERSTEIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 GARNET AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3116
Mailing Address - Country:US
Mailing Address - Phone:858-273-1970
Mailing Address - Fax:
Practice Address - Street 1:1652 GARNET AVE
Practice Address - Street 2:MINUTE CLINIC
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3116
Practice Address - Country:US
Practice Address - Phone:858-273-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15389363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ58086ZOtherBLUESHIELD OF CALIFORNIA
CATHP70010FMedicaid
CAZZZ58086ZOtherBLUESHIELD OF CALIFORNIA