Individual
ENNEMAN IRENE TAD-AWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1173 FRONT ST, SAN DIEGO, CA 92101-3904
(619) 409-5000
Mailing address
683 ASH AVE, CHULA VISTA, CA 91910-5338
(417) 860-9671
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95029080
CA
Other
Enumeration date
03/03/2025
Last updated
03/03/2025
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