Healthcare Provider Details

I. General information

NPI: 1346321569
Provider Name (Legal Business Name): ANTHONY B HAWKINS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7773 UNIVERSITY AVE
LA MESA CA
91941-4950
US

IV. Provider business mailing address

7773 UNIVERSITY AVE
LA MESA CA
91941-4950
US

V. Phone/Fax

Practice location:
  • Phone: 619-465-3000
  • Fax: 619-465-3003
Mailing address:
  • Phone: 619-465-3000
  • Fax: 619-465-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC11743
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: