Individual
MARY J. STATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
10666 N TORREY PINES RD, LA JOLLA, CA 92037-1027
(858) 554-7462
Mailing address
10790 RANCHO BERNARDO RD, SAN DIEGO, CA 92127-5705
(858) 554-7464
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
NP14515
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RN602598
—
CA
Enumeration date
02/09/2006
Last updated
12/28/2016
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