Provider Demographics
NPI:1780056267
Name:HINTON, DAVID ALEXANDER (SFIDC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALEXANDER
Last Name:HINTON
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 A ST
Mailing Address - Street 2:NONE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1010
Mailing Address - Country:US
Mailing Address - Phone:520-403-4884
Mailing Address - Fax:
Practice Address - Street 1:2632 A ST
Practice Address - Street 2:NONE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-1010
Practice Address - Country:US
Practice Address - Phone:520-403-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman