Provider Demographics
NPI:1447689609
Name:NEGRETE, STACEY MARIE (PNP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MARIE
Last Name:NEGRETE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4800
Mailing Address - Country:US
Mailing Address - Phone:858-636-4800
Mailing Address - Fax:858-636-4319
Practice Address - Street 1:25485 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 220
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-6900
Practice Address - Country:US
Practice Address - Phone:951-461-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000089363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics