Individual provider Active NPI

Medya Khamis, NP

  • Family Nurse Practitioner
  • San Diego, CA
National Provider Identifier
1639067598
Registry record updated Jun 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95033939 Issued in CA
Practice address
4060 Fairmount Ave
San Diego, CA 92105-1608
Phone
(619) 795-5991
Fax
(619) 795-5992
NPI assigned
Jun 27, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95033939 CA Primary

Addresses

Primary practice location

4060 Fairmount Ave
San Diego, CA 92105-1608

Mailing address

380 N Mollison Ave Apt 213
El Cajon, CA 92021-6800
Phone (619) 792-8147

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250918002369 CA Practitioner - Nurse Practitioner 3274037650 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
National Medical University, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

21410 NE 14TH Street
Sammamish, WA 98074

4060 Fairmount Ave
San Diego, CA 92105-1608

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95033939CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
La Maestra Family Clinic, Inc. CurrentSince Jun 12, 2025 Accepting new patients
La Maestra Family Clinic, Inc. CurrentSince Jun 12, 2025 Accepting new patients
La Maestra Family Clinic Past Accepting new patients

Locations

4074 Fairmount Ave
San Diego, CA 92105
Phone (619) 284-1141

4060 Fairmount Ave
San Diego, CA 92105
Phone (619) 255-9155

Interoperability endpoints

  • Direct secure messaging: medya.khamis.p1@direct.lamaestra.nextgenshare.com

Organizations & group practices 3

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1750982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1639067598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 N MOLLISON AVE APT 213",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920216800",
            "telephone_number": "619-792-8147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 FAIRMOUNT AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051608",
            "telephone_number": "619-795-5991",
            "fax_number": "619-795-5992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAMIS",
        "first_name": "MEDYA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-27",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95033939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.