Healthcare Provider Details

I. General information

NPI: 1780765784
Provider Name (Legal Business Name): MR. DANIEL KIRK FIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 RENDOVA ROAD
SAN DIEGO CA
92115-5490
US

IV. Provider business mailing address

2299 HILTON HEAD RD
CHULA VISTA CA
91915-1209
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-6671
  • Fax:
Mailing address:
  • Phone: 619-948-1087
  • 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: