Healthcare Provider Details

I. General information

NPI: 1396961629
Provider Name (Legal Business Name): MARY ANNE MORELLI HASKELL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 2ND ST
CORONADO CA
92118-1417
US

IV. Provider business mailing address

1203 2ND ST
CORONADO CA
92118-1417
US

V. Phone/Fax

Practice location:
  • Phone: 619-437-6600
  • Fax: 619-437-6603
Mailing address:
  • Phone: 619-437-6600
  • Fax: 619-437-6603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number#20A-5729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: