Healthcare Provider Details

I. General information

NPI: 1699791335
Provider Name (Legal Business Name): BESSIE B FLOYD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5640 LORD CECIL ST
SAN DIEGO CA
92122-3111
US

IV. Provider business mailing address

5640 LORD CECIL ST
SAN DIEGO CA
92122-3111
US

V. Phone/Fax

Practice location:
  • Phone: 858-452-9823
  • Fax: 760-479-0334
Mailing address:
  • Phone: 760-479-0977
  • Fax: 760-479-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License NumberG29973
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG29973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: