Provider Demographics
NPI:1093157604
Name:FLUVACCINE.ORG
Entity Type:Organization
Organization Name:FLUVACCINE.ORG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-812-2140
Mailing Address - Street 1:970 TURQUOISE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1141
Mailing Address - Country:US
Mailing Address - Phone:877-600-0358
Mailing Address - Fax:
Practice Address - Street 1:970 TURQUOISE ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-1141
Practice Address - Country:US
Practice Address - Phone:877-600-0358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78014261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service