Provider Demographics
NPI:1033968672
Name:DAMJI, KHADIJA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KHADIJA
Middle Name:
Last Name:DAMJI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 BROOKE CT UNIT 404
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5286
Mailing Address - Country:US
Mailing Address - Phone:416-841-6565
Mailing Address - Fax:
Practice Address - Street 1:3420 CARMEL MOUNTAIN RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1069
Practice Address - Country:US
Practice Address - Phone:858-267-4365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027470363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner