Provider Demographics
NPI:1639550833
Name:TRAVERS, NAOMI (NP)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:TRAVERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:
Other - Last Name:THEODOROU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7300 GIRARD AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5138
Mailing Address - Country:US
Mailing Address - Phone:858-900-2712
Mailing Address - Fax:858-750-2984
Practice Address - Street 1:15725 POWAY ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-5138
Practice Address - Country:US
Practice Address - Phone:858-397-5755
Practice Address - Fax:858-454-5724
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558188207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology