Mirka A Radman, CFNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

6394632 Issued in CA

Practice address

1111 Broadway Ste 305
Chula Vista, CA 91911

Phone

(619) 567-7007

Fax

(619) 567-7775

NPI assigned

Dec 8, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Mirka A Forgeron Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: mradman80471@scrippshlth.medalliesdirect.net

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.

• Scripps Health

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1487928891
  NPD
• Vascular Associates of San Diego

  • Vascular Surgery Physician
  • La Mesa, CA
  • NPI 1104975713
  NPD (past)

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

{
    "created_epoch": "1323302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1962770636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 BROADWAY STE 305",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919112700",
            "telephone_number": "619-567-7007",
            "fax_number": "619-567-7775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 BROADWAY STE 305",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "91911",
            "telephone_number": "619-567-7007",
            "fax_number": "619-567-7775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15611 Pomerado Rd Ste 505",
            "address_purpose": "LOCATION",
            "city": "Poway",
            "state": "CA",
            "postal_code": "920642437",
            "country_code": "US",
            "telephone_number": "858-264-7004",
            "fax_number": "858-264-7004",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4225 Executive Sq Ste 450",
            "address_purpose": "LOCATION",
            "city": "LA Jolla",
            "state": "CA",
            "postal_code": "920378411",
            "country_code": "US",
            "telephone_number": "858-810-8000",
            "fax_number": "858-268-1911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RADMAN",
        "first_name": "MIRKA",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-08",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "6394632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRKA",
            "last_name": "FORGERON",
            "middle_name": "A",
            "prefix": "MS.",
            "credential": "CFNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.