Provider Demographics
NPI:1821007519
Name:AHLERS, AUTUMN J
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:J
Last Name:AHLERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:J
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1716 THORLEY WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1066
Mailing Address - Country:US
Mailing Address - Phone:760-798-4265
Mailing Address - Fax:
Practice Address - Street 1:1000 VALE TERRACE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5218
Practice Address - Country:US
Practice Address - Phone:760-407-1220
Practice Address - Fax:760-414-3702
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily