Provider Demographics
NPI:1326756636
Name:HAMLIN, JOHN VINCENT (IDC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:VINCENT
Last Name:HAMLIN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 NORTHSTAR WAY APT 251
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-0961
Mailing Address - Country:US
Mailing Address - Phone:315-806-1137
Mailing Address - Fax:
Practice Address - Street 1:1970 NORTHSTAR WAY APT 251
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-0961
Practice Address - Country:US
Practice Address - Phone:315-806-1137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman