Healthcare Provider Details

I. General information

NPI: 1578379897
Provider Name (Legal Business Name): CHASE ALAN NORRIS SFIDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34101 FARENHOLT AVE BLDG 14
SAN DIEGO CA
92134-7000
US

IV. Provider business mailing address

7444 MISSION VALLEY RD
SAN DIEGO CA
92108-4406
US

V. Phone/Fax

Practice location:
  • Phone: 854-500-3067
  • Fax:
Mailing address:
  • Phone: 854-500-3067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: