Provider Demographics
NPI:1780010595
Name:ERNST, XAVIER JEREMIAH (NP-C, ABAAHP)
Entity Type:Individual
Prefix:
First Name:XAVIER
Middle Name:JEREMIAH
Last Name:ERNST
Suffix:
Gender:M
Credentials:NP-C, ABAAHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1792 GARNET AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3350
Mailing Address - Country:US
Mailing Address - Phone:415-745-0225
Mailing Address - Fax:888-960-9058
Practice Address - Street 1:1792 GARNET AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3350
Practice Address - Country:US
Practice Address - Phone:415-745-0225
Practice Address - Fax:888-960-9058
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2019028369363LF0000X
IAA161882363LF0000X
IL277001251363LF0000X
NM62149363LF0000X
CA95002510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily