Provider Demographics
NPI:1730642869
Name:ANIMUS, INVICTUS PREVAIL
Entity Type:Individual
Prefix:
First Name:INVICTUS
Middle Name:PREVAIL
Last Name:ANIMUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 MEADE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4251
Mailing Address - Country:US
Mailing Address - Phone:760-271-4020
Mailing Address - Fax:
Practice Address - Street 1:2929 MEADE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4251
Practice Address - Country:US
Practice Address - Phone:760-271-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-06
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist