Provider Demographics
NPI:1215456298
Name:LAXA, RUSSE ELLA MUNAR (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:RUSSE ELLA
Middle Name:MUNAR
Last Name:LAXA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:RUSSE ELLA
Other - Middle Name:MUNAR
Other - Last Name:IGNACIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD # 4S-205
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:760-806-5400
Mailing Address - Fax:
Practice Address - Street 1:130 CEDAR RD
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5102
Practice Address - Country:US
Practice Address - Phone:760-806-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily