Individual
BITA KODI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC, FNP-BC
Contact information
Practice address
561 SAXONY PL STE 101, ENCINITAS, CA 92024-7700
(760) 503-4703
Mailing address
561 SAXONY PL STE 101, ENCINITAS, CA 92024-7700
(760) 503-4703
Taxonomy
Speciality
Code
Description
License number
State
261QC1800X
Corporate Health Clinic/Center
95010378
CA
261QP2300X
Primary Care Clinic/Center
95010378
CA
261QX0100X
Occupational Medicine Clinic/Center
95010378
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95010378
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP95010378
FNP LICENSE NUMBER
CA
01
—
NPF95010378
NP FURNISHING NUMBER
CA
Enumeration date
04/30/2019
Last updated
05/25/2023
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