Provider Demographics
NPI:1770025165
Name:HITCHENS, MARY E (LVN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:HITCHENS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 HOT SPRINGS WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7878
Mailing Address - Country:US
Mailing Address - Phone:858-751-9632
Mailing Address - Fax:
Practice Address - Street 1:1315 HOT SPRINGS WAY STE 101
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7878
Practice Address - Country:US
Practice Address - Phone:858-751-9632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52597224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter