Provider Demographics
NPI:1619391356
Name:NAFUS, PHILLIP (INDEPEDENT DUTY CORP)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:
Last Name:NAFUS
Suffix:
Gender:M
Credentials:INDEPEDENT DUTY CORP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1098
Mailing Address - Country:US
Mailing Address - Phone:619-556-0662
Mailing Address - Fax:
Practice Address - Street 1:3685 CUMMINGS RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-0001
Practice Address - Country:US
Practice Address - Phone:619-556-0662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman