Healthcare Provider Details

I. General information

NPI: 1043281850
Provider Name (Legal Business Name): DAVID MARK EDWARD LLEWELLYN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE NHCP INTERNAL MEDICINE
OCEANSIDE CA
92055
US

IV. Provider business mailing address

200 MERCY CIRCLE NHCP INTERNAL MEDICINE
OCEANSIDE CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 928-649-7991
  • Fax:
Mailing address:
  • Phone: 760-719-3682
  • Fax: 760-725-1690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG144603
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG143603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: