MEDICARE: MR. PRESTON P. THRIFT IDC, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1164637005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PRESTON P. THRIFT IDC, RN

Provider Business Mailing Address
First Line	:	35938 RHONE LN
Second Line	:
City	:	WINCHESTER
State	:	CA
Zip	:	92596-9165
Country	:	US
Telephone Number	:	951-926-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	53560 HULL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92152-5001
Country	:	US
Telephone Number	:	619-553-1536
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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