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General NPI Number Information
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NPI Number | 1275843732
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Entity Type | Organization
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Legal Business Name | UNITED STATES AIR FORCE
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 11075 SANTA MONICA BLVD STE 300
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City | LOS ANGELES
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State | CA
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Zip | 90025-7540
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Country | US
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Telephone | 310-481-5089
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Fax |
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Provider Business Mailing Address
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Address Line | 10333 CAMINO RUIZ APT 39
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City | SAN DIEGO
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State | CA
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Zip | 92126-3284
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Country | US
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Telephone | 858-837-3510
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST (STUDENT)
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Name | SARAH EMMA THOMPSON
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Credential | M.A.
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Telephone | 310-481-5089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number |
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License Number State |
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