MRS. CRYSTAL FAITH DETHLEFS


Address: 34101 Farenholt Ave, San Diego, CA 92134-7000
Phone: 6195327968

MRS. CRYSTAL FAITH DETHLEFS (NPI# 1659914315) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1659914315
Entity Type Individual
Full Name MRS. CRYSTAL FAITH DETHLEFS
Practice Address 34101 Farenholt Ave
San Diego
CA 92134-7000
Mailing Address 34101 Farenholt Ave
San Diego
CA 92134-0001
Practice Telephone 6195327968
Mailing Telephone 6195327968
Enumeration Date 2019-10-24
Last Update Date 2019-10-24
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 1710I1002X Military Health Care Provider
Specialization: Independent Duty Corpsman
Other Service Providers

Office Location

Street Address 34101 FARENHOLT AVE
City SAN DIEGO
State CA
Zip Code 92134-7000

Providers in the same location

NPI Name Taxonomy Address Enumeration
1376522193 Anna Gruetzmacher Registered Nurse 34101 Farenholt Ave, Nshs-sd Idc, San Diego, CA 92134-7000 2006-01-11
1992316541 Michael Trey Wix Military Health Care Provider 34101 Farenholt Ave, San Diego, CA 92134-7000 2020-08-16
1063023737 James Anthony Lukas IIi Military Health Care Provider 34101 Farenholt Ave, San Diego, CA 92134-7000 2020-08-14
1477164143 Evan Lewis Ridenour Military Health Care Provider 34101 Farenholt Ave, San Diego, CA 92134-7000 2020-08-14
1295353175 Derek R Summers Military Health Care Provider 34101 Farenholt Ave, San Diego, CA 92134-7000 2020-07-08
1992326854 Brandon Ponder Military Health Care Provider 34101 Farenholt Ave, San Diego, CA 92134-7000 2020-05-01
1912535493 Michael Johnson Military Health Care Provider 34101 Farenholt Ave, San Diego, CA 92134-7000 2020-03-30
1023655313 Kayla Seim Military Health Care Provider 34101 Farenholt Ave, San Diego, CA 92134-7000 2019-12-05
1871130104 Eric Ancheta Military Health Care Provider 34101 Farenholt Ave, San Diego, CA 92134-7000 2019-12-05
1811533656 Andres Ricardo Castaneda Military Health Care Provider 34101 Farenholt Ave, San Diego, CA 92134-7000 2019-11-26
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1477178457 Joseph Hunter Sampson Military Health Care Provider 34101 Farenholt Ave #14, San Diego, CA 92134 2020-06-15
1508495201 Benjamin Michael Taylor Military Health Care Provider Naval Medical Center San Diego Psychiatry Residency Pgm, 34800 Bob Wilson Drive, San Diego, CA 92134 2020-04-04
1255870333 Dosh Page Physician Assistant Swmi Farenholt Avenue, Building 14, San Diego, CA 92134 2017-02-22
1417328063 Noem Clay Gallego Military Health Care Provider 34101 Building 14, Farenholt Avenue, San Diego, CA 92134 2015-10-08
1972999183 Justin Paul Lachney Military Health Care Provider 34101 Farenholt Avenue, San Diego, CA 92134 2015-04-14
1174963532 Ryan Anders Crane Otolaryngology Department of Otolaryngology - Nmc San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 2013-07-01
1447591268 Amy B. Cornell Student in an Organized Health Care Education/Training Program 34800 Bob Wilson Drive, San Diego, Ca, Apo, AA 92134 2013-03-04
1841562956 Christopher Patrick Androski Jr. Emergency Medical Technician, Basic Naval Medical Center San Diego 38400 Bob Wilson Dr, San Diego, CA 92134 2012-02-04
1164717740 Jason James Weiner Internal Medicine Dept of Internal Medicine, Division of Rheumatology, 34800 Bob Wilson Drive, San Diego, CA 92134 2011-06-13
1225320237 Kimberly Ann Thompson Student in an Organized Health Care Education/Training Program Navy Medical Center San Diego Gme Department, 34800 Bob Wilson Dr., San Diego, CA 92134 2011-05-09
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Taxonomy Information

Taxonomy Code 1710I1002X
Grouping Other Service Providers
Classification Military Health Care Provider
Specialization Independent Duty Corpsman

Taxonomy Definition

A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.
Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1770180648 Darius Lee Sean Woods Military Health Care Provider 6033 Sandy Shore Ct, San Diego, CA 92139-1014 2020-10-05
1174130744 Daniel Carrera Military Health Care Provider 2645 W Canyon Ave Apt 450, San Diego, CA 92123-4700 2020-09-28
1316551740 Kyle Bode Francis Military Health Care Provider 3149 Murray Ridge Rd, San Diego, CA 92123-2917 2020-09-02
1255945069 Jeremy Lee Military Health Care Provider 509 Dennery Rd Apt 145, San Diego, CA 92154-8542 2020-08-31
1013520667 Rashaad Brown Military Health Care Provider 4454 Cherokee Ave Apt 2, San Diego, CA 92116-3611 2020-08-24
1932711934 Alvaro Daniel Macias Military Health Care Provider 8685 Rio San Diego Dr Apt 4344, San Diego, CA 92108-6560 2020-08-20
1689286189 Charles Luke Morris Military Health Care Provider 1675 Beta Ct, San Diego, CA 92126-7060 2020-08-18
1255943635 Stephon Peyton Frost Military Health Care Provider 2654 Mendonca Dr, San Diego, CA 92110-4263 2020-08-18
1184235871 Jaden Sandi Military Health Care Provider Swmi Sfidc Bldg 14 34101 Farenholt Ave, San Diego, CA 92134-0001 2020-08-14
1477178457 Joseph Hunter Sampson Military Health Care Provider 34101 Farenholt Ave #14, San Diego, CA 92134 2020-06-15
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Competitor

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City SAN DIEGO
Zip Code 92134

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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