Provider Demographics
NPI:1306420450
Name:NEGRON, MICHAEL ANGELLO (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANGELLO
Last Name:NEGRON
Suffix:
Gender:M
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:ANGELLO
Other - Last Name:NEGRON VIDAURRE(MAIDEN NAME)
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3350 LA JOLLA VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-0002
Mailing Address - Country:US
Mailing Address - Phone:858-552-8585
Mailing Address - Fax:
Practice Address - Street 1:8875 AERO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2251
Practice Address - Country:US
Practice Address - Phone:619-400-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-100845163W00000X
CA795770163W00000X
HIAPRN-3282363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse