Provider Demographics
NPI:1174918585
Name:ADEIZA, JOHN D (NP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:ADEIZA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S GRAPE ST STE 4
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4407
Mailing Address - Country:US
Mailing Address - Phone:858-546-4300
Mailing Address - Fax:858-876-9497
Practice Address - Street 1:106 S GRAPE ST STE 4
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4407
Practice Address - Country:US
Practice Address - Phone:888-628-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001818363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner