Marisa Deptala, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95005347 Issued in CA

Practice address

450 4TH Ave Ste 408
Chula Vista, CA 91910-4430

Phone

(619) 691-1990

NPI assigned

Oct 31, 2016

Last updated

Apr 13, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jean Rizkallah, M.D., IncGroup PAC ID 9335272830, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jean Rizkallah, MD, Inc

  • Family Medicine Physician
  • Chula Vista, CA
  • NPI 1760702237
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523577600000",
    "number": "1083166615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 FOURTH AVE STE 408",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919104430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 4TH AVE STE 408",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919104430",
            "telephone_number": "619-691-1990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8695 Spectrum Center Blvd",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921231489",
            "country_code": "US",
            "telephone_number": "858-499-5259",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEPTALA",
        "first_name": "MARISA",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-31",
        "last_updated": "2018-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95005347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ciara Villagran Dennison, LCSW
• Dental Check-Up
• Dentists of Chula Vista Hazzaa Yahya Gen PTR (Dental Group Palomar)
• Brian Curtis Denton
• Department of VA
• Dermatology & Laser Center of San Diego
• Lecille Marchan Desamparado, MSN, FNP-C
• Annaliz Desantiago Flemate
• Joanne Desiere, COTA/L
• Leticia Desmond

• Family Nurse Practitioner in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.