Healthcare Provider Details

I. General information

NPI: 1245016906
Provider Name (Legal Business Name): EVERSIDE HEALTH CA IRONWORKERS-CHULA VISTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 4TH AVE STE 14
CHULA VISTA CA
91910-3813
US

IV. Provider business mailing address

10 W MARKET ST STE 2900
INDIANAPOLIS IN
46204-2964
US

V. Phone/Fax

Practice location:
  • Phone: 704-661-1380
  • Fax:
Mailing address:
  • Phone: 317-869-3164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARLA SPIVEY
Title or Position: CENTRAL SUPPORT SPECIALIST
Credential:
Phone: 317-869-3164