Healthcare Provider Details

I. General information

NPI: 1932169380
Provider Name (Legal Business Name): SHIRLEY HOVLID
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 STOCKTON RD
SAN DIEGO CA
92106-6000
US

IV. Provider business mailing address

1032 21ST ST
SAN DIEGO CA
92102-1816
US

V. Phone/Fax

Practice location:
  • Phone: 619-524-1368
  • Fax:
Mailing address:
  • Phone: 619-321-7544
  • 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: