MR. LARRY ODELL NEELY IDC NPI 1568719821

NPI Information

NPI: 1568719821
Provider Name: MR. LARRY ODELL NEELY, IDC
Classification: Military Health Care Provider - 171000000X
Entity Type: Individual
Address:
34101 FARENHOLT AVE BLDG 14
SAN DIEGO, CA
ZIP 92134
Phone: (619) 532-6195
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MR. Larry Odell Neely, IDC is a military health care provider in San Diego, CA. The provider is active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. MR. Larry Odell Neely, IDC NPI is 1568719821. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

34101 FARENHOLT AVE BLDG 14
SAN DIEGO, CA
ZIP 92134-291
Phone: (619) 532-6195

The enumeration date for this NPI number is 8/6/2012 and was last updated on 8/6/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	171000000X	Military Health Care Provider				Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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