Healthcare Provider Details

I. General information

NPI: 1619109949
Provider Name (Legal Business Name): JEFFREY SCOTT AICHELMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NOMI DET SWMI 34101 FARENHOLT AVE
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

3636 NILE ST
SAN DIEGO CA
92104-3819
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-2914
  • Fax:
Mailing address:
  • Phone: 760-521-3642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: