Provider Demographics
NPI:1184644411
Name:FOMON-MAISEL, FRANCINE THOMPSON (NP)
Entity Type:Individual
Prefix:MS
First Name:FRANCINE
Middle Name:THOMPSON
Last Name:FOMON-MAISEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:FRANCINE
Other - Middle Name:MARIE
Other - Last Name:FOMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:13252 NORCROFT RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1285
Mailing Address - Country:US
Mailing Address - Phone:858-259-6009
Mailing Address - Fax:
Practice Address - Street 1:SDVA HEALTHCARE SYSTEM
Practice Address - Street 2:3350 LA VILLAGE DR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0001
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:858-642-6325
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily