Healthcare Provider Details

I. General information

NPI: 1942270442
Provider Name (Legal Business Name): THOMAS ALBERT SWEET RN, MSN, CNOR
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR NMCSD, ATTN: MEDICAL STAFF SERVICES
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

1250 POPLAR SPRING RD
CHULA VISTA CA
91915-2515
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8645
  • Fax: 619-532-5500
Mailing address:
  • Phone: 619-934-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number4704155609
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: