Basic Information
| Provider Information | |||||||||
| NPI: | 1033556501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRICE | ||||||||
| FirstName: | HITTA | ||||||||
| MiddleName: | JENNIFER | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5379 BALBOA AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921176913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584058926 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5379 BALBOA AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921176913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584058926 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2013 | ||||||||
| LastUpdateDate: | 05/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 22559 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 22559 | 01 | CA | NURSE PRACTITIONER | OTHER |