Healthcare Provider Details

I. General information

NPI: 1497408405
Provider Name (Legal Business Name): KYLE JOHN LABBAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CENTER SAN DIEGO 38400 BOB WILSON DR
SAN DIEGO CA
92134-5000
US

IV. Provider business mailing address

NAVAL MEDICAL CENTER SAN DIEGO 38400 BOB WILSON DR
SAN DIEGO CA
92134-5000
US

V. Phone/Fax

Practice location:
  • Phone: 480-266-8918
  • Fax:
Mailing address:
  • Phone: 480-266-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102208107
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: