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NPI Code Detail

MEDICARE: MR. MICHAEL ALAN HAWKINS FNP

MEDICARE: MR. MICHAEL ALAN HAWKINS FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner95008845CA
2363LF0000XFamily Nurse Practitioner645712TX

General Provider Information

NPI Number : 1619965639
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL ALAN HAWKINS FNP
Provider Business Mailing Address
First Line : 821 REGULO PL APT 1734
Second Line :
City : CHULA VISTA
State : CA
Zip : 91910-7767
Country : US
Telephone Number : 210-563-5689
Fax Number :
Provider Business Practice Location Address
First Line : 3350 LA JOLLA VILLAGE DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92161-0002
Country : US
Telephone Number : 858-552-8585
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 07/21/2022

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