Provider Demographics
NPI:1962770636
Name:RADMAN, MIRKA A (CFNP)
Entity type:Individual
Prefix:MS
First Name:MIRKA
Middle Name:A
Last Name:RADMAN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:MS
Other - First Name:MIRKA
Other - Middle Name:A
Other - Last Name:FORGERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:1111 BROADWAY STE 305
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2700
Mailing Address - Country:US
Mailing Address - Phone:619-567-7007
Mailing Address - Fax:619-567-7775
Practice Address - Street 1:1111 BROADWAY STE 305
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911
Practice Address - Country:US
Practice Address - Phone:619-567-7007
Practice Address - Fax:619-567-7775
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6394632363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner