Healthcare Provider Details

I. General information

NPI: 1588621700
Provider Name (Legal Business Name): DOVE A COLTHARP CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 AREA BRANCH CLINIC CAMP PENDLETON
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

4926 LOMA WAY
CARLSBAD CA
92008-3806
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-6682
  • Fax:
Mailing address:
  • Phone: 760-434-0086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number432979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: