Healthcare Provider Details

I. General information

NPI: 1760838759
Provider Name (Legal Business Name): CARL A NORMAN INDEPENDENT DUTY HM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 THUNDER GLN
ESCONDIDO CA
92027-3976
US

IV. Provider business mailing address

630 THUNDER GLN
ESCONDIDO CA
92027-3976
US

V. Phone/Fax

Practice location:
  • Phone: 703-906-8615
  • Fax:
Mailing address:
  • Phone: 703-906-8615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: