Healthcare Provider Details

I. General information

NPI: 1457300204
Provider Name (Legal Business Name): MICHAL IRIS HOSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA SAN DIEGO HEALTHCARE 3350 LA JOLLA VILLAGE DR., MC 111
SAN DIEGO CA
92161-0001
US

IV. Provider business mailing address

VA SAN DIEGO HEALTHCARE 3350 LA JOLLA VILLAGE DR., MC 111
SAN DIEGO CA
92161-0001
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8585
  • Fax:
Mailing address:
  • Phone: 858-552-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberA72620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: