Healthcare Provider Details

I. General information

NPI: 1295142974
Provider Name (Legal Business Name): RENEE HOTCHKISS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL STATION SAN DIEGO
SAN DIEGO CA
92136-0001
US

IV. Provider business mailing address

617 RICHMAR AVE APT 120
SAN MARCOS CA
92069-6503
US

V. Phone/Fax

Practice location:
  • Phone: 760-224-9135
  • Fax:
Mailing address:
  • Phone:
  • 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: