Healthcare Provider Details

I. General information

NPI: 1689856221
Provider Name (Legal Business Name): MR. TERRENCE TREMAYNE LAWSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMC SD MERCY DET 3395 STURTEVANT ST SUITE 1
SAN DIEGO CA
92136-5075
US

IV. Provider business mailing address

3395 STURTEVANT ST SUITE 1 NMC SD MERCY DET
SAN DIEGO CA
92136-5075
US

V. Phone/Fax

Practice location:
  • Phone: 803-410-0586
  • Fax:
Mailing address:
  • Phone: 803-410-0586
  • 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: