DR. WAYNE ELLSWORTH SPRUCE (NPI# 1780761320) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780761320 |
| Entity Type | Individual |
| Full Name | DR. WAYNE ELLSWORTH SPRUCE |
| Credential | MD |
| Practice Address |
6160 Mission Gorge Rd Suite 400 San Diego CA 92120-3410 |
| Mailing Address |
2870 Dove Tail Dr San Marcos CA 92078-0933 |
| Practice Telephone | 6195284010 |
| Practice Fax Number | 6195284077 |
| Mailing Telephone | 7602903678 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2011-07-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0207X |
Pediatrics Specialization: Pediatric Hematology-Oncology |
A24022 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00A240220 | 05 |
| Street Address |
6160 MISSION GORGE RD SUITE 400 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92120-3410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336104629 | Denney R Barrus | Social Worker | 6160 Mission Gorge Rd, Suite 200, San Diego, CA 92120-3410 | 2006-04-19 |
| 1669071627 | Felicia Elizabeth Nassif | Registered Nurse | 6160 Mission Gorge Rd, San Diego, CA 92120-3410 | 2020-10-21 |
| 1962014001 | Paulina Alvarado | Peer Specialist | 6160 Mission Gorge Rd, San Diego, CA 92120-3410 | 2020-08-19 |
| 1568081719 | Kristin Catherine Mcconnell | Student in an Organized Health Care Education/Training Program | 6160 Mission Gorge Rd, San Diego, CA 92120-3410 | 2020-04-08 |
| 1477184919 | Sean Arthur Smith | Licensed Vocational Nurse | 6160 Mission Gorge Rd, San Diego, CA 92120-3410 | 2020-02-03 |
| 1225671704 | Kendall Fitzpatrick | Case Manager/Care Coordinator | 6160 Mission Gorge Rd, San Diego, CA 92120-3410 | 2019-10-28 |
| 1649831660 | Paris Jackson | Case Manager/Care Coordinator | 6160 Mission Gorge Rd, San Diego, CA 92120-3410 | 2019-06-21 |
| 1730641408 | Shea Prophet | Marriage & Family Therapist | 6160 Mission Gorge Rd, San Diego, CA 92120-3410 | 2019-04-02 |
| 1902361181 | Ivette Quintero | Counselor | 6160 Mission Gorge Rd, San Diego, CA 92120-3410 | 2019-02-01 |
| 1679048417 | Taylor Nicole Nanquil Valdivia | Marriage & Family Therapist | 6160 Mission Gorge Rd, San Diego, CA 92120-3410 | 2018-10-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316550510 | Jessica Elizabeth Knight | Student in an Organized Health Care Education/Training Program | 6383 Alvarado Ct, 310, San Diego, CA 92120 | 2020-08-26 |
| 1770195091 | Julia Roccanova | Student in an Organized Health Care Education/Training Program | 6383 Alvarado Court, Suite 310, San Diego, CA 92120 | 2020-08-18 |
| 1225593601 | Truself Training, Inc | Clinic/Center | 5125 Waring Road, San Diego, CA 92120 | 2019-02-09 |
| 1508381799 | Antin Sachs | In Home Supportive Care | 4420 Rainier Avenue, Suite 202, San Diego, CA 92120 | 2017-08-08 |
| 1588186415 | Matthew B Wilbat | Behavioral Analyst | 6851 Alvarado Rd., #17, San Diego, CA 92120 | 2017-07-12 |
| 1548782923 | Mori Khatibzadeh Dds Inc. | Clinic/Center | 6171 Mission Gorge Road, Suite #114, San Diego, CA 92120 | 2017-07-07 |
| 1306379359 | Ken Samith Oerding | Nurse Practitioner | 5422 Reservoir Drive, E7, San Diego Ca, CA 92120 | 2017-04-06 |
| 1396134409 | Debra Michele Stern-ellis | Social Worker | 4647 Zion Avenue Kaiser Permanente, 2nd Floor - Oncology, San Diego, CA 92120 | 2015-01-13 |
| 1821494717 | Shohreh Tourian | Dentist | 7451 Mission Gorge Road, San Diego, CA 92120 | 2014-11-05 |
| 1184049215 | Charles Yin | Counselor | 6153 Fairmount Ave Suite #260, San Diego, CA 92120 | 2014-02-26 |
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| Taxonomy Code | 2080P0207X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Hematology-Oncology |
| A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447527833 | Nicholas Joseph Gloude | Pediatrics | 3010 Childrens Way Fl 2, San Diego, CA 92123-4223 | 2011-11-29 |
| 1104261502 | Katherine Clark Pehlivan | Pediatrics | 3010 Childrens Way # 2-west, San Diego, CA 92123-4223 | 2013-04-30 |
| 1154662583 | Maria Paula Aristizabal | Pediatrics | 3010 Childrens Way, 2-west, San Diego, CA 92123-4223 | 2013-03-11 |
| 1326315599 | Jennifer Caroline Yu | Pediatrics | 3010 Childrens Way, 2-west, San Diego, CA 92123-4223 | 2011-11-16 |
| 1568510543 | Pamela J. Lammers | Pediatrics | 4647 Zion Ave, San Diego, CA 92120-2507 | 2007-01-08 |
| 1962550939 | Wellington Loh Jr. | Pediatrics | 4647 Zion Ave, San Diego, CA 92120-2507 | 2007-01-08 |
| 1306900022 | Ralph Charles Pene | Pediatrics | 34800 Bob Wilson Drive, San Diego, CA 92134 | 2006-12-20 |
| 1255403879 | Hyunah Ahn | Pediatrics | 3010 Childrens Way, 2-west, San Diego, CA 92123-4223 | 2006-11-15 |
| 1245302561 | William Delbert Roberts | Pediatrics | 3010 Childrens Way, 2-west, San Diego, CA 92123-4223 | 2006-11-14 |
| 1922179779 | Deborah Ellen Schiff | Pediatrics | 3010 Childrens Way, 2-west, San Diego, CA 92123-4223 | 2006-11-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.