Healthcare Provider Details

I. General information

NPI: 1477666162
Provider Name (Legal Business Name): CAROLE F HAIR PHD, APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DRI VA SAN DIEGO HEALTHCARE SYSTEM
SAN DIEGO CA
92161-0001
US

IV. Provider business mailing address

3350 LA JOLLA VILLAGE DR VA SAN DIEGO HEALTHCARE SYSTEM
SAN DIEGO CA
92161-0001
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8585
  • Fax: 858-552-7422
Mailing address:
  • Phone: 858-552-8585
  • Fax: 858-552-7422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number471605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: