1780920165 NPI number — CHRISTIAN RICHARD FLOHR NAVY DIVE IDC

Table of content: CHRISTIAN RICHARD FLOHR NAVY DIVE IDC (NPI 1780920165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780920165 NPI number — CHRISTIAN RICHARD FLOHR NAVY DIVE IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLOHR
Provider First Name:
CHRISTIAN
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NAVY DIVE IDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780920165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3254 MCCLOY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92124-3639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-502-9952
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1498 13TH ST
Provider Second Line Business Practice Location Address:
BLDG 193
Provider Business Practice Location Address City Name:
IMPERIAL BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91932-3746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-437-9845
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2012

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: 171000000X , 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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