Jennifer Lynne Detisch
Nurse Practitioner (Family)

Address: 1000 Vale Terrace Dr, Vista, CA 92084-5218
Phone: 7606315000

Jennifer Lynne Detisch (NPI# 1730215534) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1730215534
Entity Type Individual
Full Name Jennifer Lynne Detisch
Credential NP
Gender Female
Practice Address 1000 Vale Terrace Dr
Vista
CA 92084-5218
Practice Telephone 7606315000
Practice Fax Number 7604143713
Mailing Address 1000 Vale Terrace Dr
Vista
CA 92084-5218
Sole Proprietor No, this individual is not a Sole Proprietor
Enumeration Date 2007-02-26
Last Update Date 2010-08-04

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 363LF0000X Nurse Practitioner · Family Physician Assistants & Advanced Practice Nursing Providers 16773 CA

Physician Overview

NPI 1730215534
PAC ID by PECOS 1557543048
Professional Enrollment ID I20110304000066
Full Name Jennifer L. Detisch
Organization Legal Name SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Phone Number 6195285000
Gender F
Medical School UNIVERSITY OF CALIFORNIA, SAN FRANCISCO SCHOOL OF MEDICINE
Graduation Year 2006
Primary Specialty NURSE PRACTITIONER
Group Practice PAC ID 6002729175
Number of Group Practice Members 7216
Accepts Medicare Assignment Y

Office Location

Street Address 1000 VALE TERRACE DR
City VISTA
State CA
Zip Code 92084-5218

Providers in the same location

NPI Name Taxonomy Address Enumeration
1598163560 Angela Boomsma Nurse Practitioner 1000 Vale Terrace Dr, Vista, CA 92084-5218 2014-12-08
1942776166 Angelica Aguilera Fox Dental Hygienist 1000 Vale Terrace Dr, Vista, CA 92084-5218 2018-10-15
1528552502 Laura Lee Williams Dental Hygienist 1000 Vale Terrace Dr, Vista, CA 92084-5218 2018-06-21
1013407170 Carly Beth Welch Nurse Practitioner 1000 Vale Terrace Dr, Vista, CA 92084-5218 2018-05-15
1104320241 Rory Skopek Nurse Practitioner 1000 Vale Terrace Dr, Vista, CA 92084-5218 2018-03-22
1376055160 Jennifer Mccleary Nurse Practitioner 1000 Vale Terrace Dr, Vista, CA 92084-5218 2017-11-01
1811407208 Maria Eugenia Segura Dental Hygienist 1000 Vale Terrace Dr, Vista, CA 92084-5218 2017-10-11
1992225528 Luis Troche Dental Hygienist 1000 Vale Terrace Dr, Vista, CA 92084-5218 2017-06-24
1306373477 Erin Leigh Edwards Registered Nurse 1000 Vale Terrace Dr, Vista, CA 92084-5218 2017-05-18
1891236063 Lois Ochrym Social Worker 1000 Vale Terrace Dr, Vista, CA 92084-5218 2017-03-20
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1912483421 James Foster Community Health Worker 1020 S Santa Fe Ave Ste B1, Vista, CA 92084 2018-07-17
1750766192 Olivia Del Valle Dental Hygienist 1000 Vale Tarrace, Vista, CA 92084 2015-07-28
1609288497 May Tom Dietitian, Registered 29402 Spa Havens Way, Vista, CA 92084 2014-05-28
1972924454 Erica Harris Student in an Organized Health Care Education/Training Program 300 Michigan Ave, Vista, CA 92084 2013-12-30
1023392008 Timothy Wong Pharmacist 802 S Santa Fe Ave, Vista, CA 92084 2011-10-07
1811296288 Jennifer Prince Pediatrics 1000 Vale Terrance Dr, Vista, CA 92084 2011-03-24
1093948424 Deborah Denise Butcher Psychologist 1259 Sugarbush Drive, Vista, CA 92084 2009-09-02
1699922062 Patricia Kay Oquist Marriage & Family Therapist 1370 Barbara Drive, Vista, CA 92084 2008-08-27
1376715045 Steve Michael Nave Dentist 933 A Vale Terrace Drive, Vista, CA 92084 2008-04-02
1780868844 Randell Brandon Murphy Counselor 1010 E Vista Way Suite F, Vista, CA 92084 2007-12-26
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Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to comeā€¦

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1740772698 Olivia Kealani Robinson Chatham Nurse Practitioner 950 Civic Center Dr # A, Vista, CA 92083-5208 2018-06-05
1831648880 Vera Cordova Nurse Practitioner 708 Titanium Pl, Vista, CA 92083-4420 2016-09-30
1598163560 Angela Boomsma Nurse Practitioner 1000 Vale Terrace Dr, Vista, CA 92084-5218 2014-12-08
1407170590 Keira Kathleen Dillon Nurse Practitioner 3030 Enterprise Ct, Vista, CA 92081-8362 2010-03-18
1184714289 Tarabeth Accardi Nurse Practitioner 1680 S Melrose Dr Ste 105, Vista, CA 92081-5472 2006-10-13
1104320241 Rory Skopek Nurse Practitioner 1000 Vale Terrace Dr, Vista, CA 92084-5218 2018-03-22
1376055160 Jennifer Mccleary Nurse Practitioner 1000 Vale Terrace Dr, Vista, CA 92084-5218 2017-11-01
1215456298 Russe Ella Munar Laxa Nurse Practitioner 130 Cedar Rd, Vista, CA 92083-5102 2017-09-11
1063930915 David Mark Chaffee Nurse Practitioner 130 Cedar Rd, Vista, CA 92083-5102 2017-08-30
1083139190 Emily Ann Lee Nurse Practitioner 1964 Via Ctr, Vista, CA 92081 2017-08-09
Find all providers in VISTA

Competitor

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City VISTA
Zip Code 92084

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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