Individual provider · Type 1 NPI

Marie Louise Fagan, IDC

Military Health Care Provider · San Diego, CA

NPI number 1104261726 Active

Practice location

4077 32nd St, Apt 8
San Diego, CA 92104-2080

Call (678) 764-4067 Map

Specialties and licenses

TaxonomyCodeLicense
Military Health Care Provider Primary 171000000XNone listed

Military Health Care Provider: Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.

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About NPI 1104261726

Marie Louise Fagan, IDC's National Provider Identifier is 1104261726, issued on May 9, 2013. The primary taxonomy on file is Military Health Care Provider (171000000X), and the practice location is in San Diego, CA. The record was last updated on May 9, 2013.