1801868633 NPI number — DR. MICHAEL GRIFFIN SWANSON D.O.

Table of content: DR. MICHAEL GRIFFIN SWANSON D.O. (NPI 1801868633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801868633 NPI number — DR. MICHAEL GRIFFIN SWANSON D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWANSON
Provider First Name:
MICHAEL
Provider Middle Name:
GRIFFIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWANSON
Provider Other First Name:
MICHAEL
Provider Other Middle Name:
GRIFFIN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1801868633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45450 PEACOCK PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMECULA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92592-4828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-261-8611
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MCRD BRANCH HEALTH CLINIC
Provider Second Line Business Practice Location Address:
35000 GUADALCANAL AVE
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92140-5002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-524-4079
Provider Business Practice Location Address Fax Number:
619-521-0852
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  20A 9658 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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