Healthcare Provider Details

I. General information

NPI: 1275855322
Provider Name (Legal Business Name): MS. BREANNA MARIE HAMILTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CTR 34800 BOB WILSON DR.
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

378 VANCE ST APT 5
CHULA VISTA CA
91910-4573
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-6400
  • Fax:
Mailing address:
  • Phone: 619-993-1143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: