Provider Demographics
NPI:1275843732
Name:UNITED STATES AIR FORCE
Entity Type:Organization
Organization Name:UNITED STATES AIR FORCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST (STUDENT)
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:EMMA
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:310-481-5089
Mailing Address - Street 1:10333 CAMINO RUIZ APT 39
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-3284
Mailing Address - Country:US
Mailing Address - Phone:858-837-3510
Mailing Address - Fax:
Practice Address - Street 1:11075 SANTA MONICA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7540
Practice Address - Country:US
Practice Address - Phone:310-481-5089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital