Individual provider Active NPI

Tania Kasandra Huezoaguilar, FNP-DNP

  • Nurse Practitioner
  • San Diego, CA
National Provider Identifier
1639886161
Registry record updated Nov 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95022003 Issued in CA
Practice address
4077 Fifth Ave
San Diego, CA 92103-2105
Phone
(619) 251-4024
NPI assigned
Nov 3, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 95022003 CA Primary

Addresses

Primary practice location

4077 Fifth Ave
San Diego, CA 92103-2105

Mailing address

1824 Teton Pass St
El Cajon, CA 92019-4204
Phone (619) 251-4024

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
I20230328000568 CA Practitioner - Nurse Practitioner 1254705585 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Reznik Medical GroupGroup PAC ID 2961758123, 5 clinicians
Scripps Health Inpatient Providers Medical Group IncGroup PAC ID 9436314762, 209 clinicians

Practice addresses (Care Compare)

4077 5TH Ave
San Diego, CA 92103-2105
Phone (619) 294-8111

435 H St
Chula Vista, CA 91910-4307
Phone (619) 691-7000

Hospital & facility affiliations

  • Scripps Mercy Hospital Hospital, San Diego, CA, CCN 050077

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95022003CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Reznik Medical Group CurrentSince Dec 12, 2023 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health Inpatient Providers Medical Group Inc. CurrentSince Feb 18, 2023 Accepting new patients
Scripps Health Past Accepting new patients

Locations

435 H St
Chula Vista, CA 91910
Phone (619) 691-7000

10790 Rancho Bernardo Rd
San Diego, CA 92127
Phone (858) 554-2626

4077 5th Ave
San Diego, CA 92103
Phone (619) 260-7245

Organizations & group practices 4

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": "1667433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667433600000",
    "number": "1639886161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1824 TETON PASS ST",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920194204",
            "telephone_number": "619-251-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4077 FIFTH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032105",
            "telephone_number": "619-251-4024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUEZOAGUILAR",
        "first_name": "TANIA",
        "middle_name": "KASANDRA",
        "name_prefix": "Ms.",
        "credential": "FNP-DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-03",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95022003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.