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MARIE LOUISE FAGAN IDC
NPI 1104261726
Military Health Care Provider in San Diego, CA

Active since May 09, 2013
4077 32ND ST, APT 8, SAN DIEGO, CA 92104(678) 764-4067 Get Directions Write a Review

NPPES record last updated: May 9, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Marie Louise Fagan Idc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARIE LOUISE FAGAN IDC (NPI 1104261726) is an individual military health care provider provider in San Diego, California and active in the NPI registry since May 2013.

NPPES Registry Identity

NPI1104261726
Entity TypeIndividualFemale
Primary Taxonomy171000000X
Provider Legal NameMARIE LOUISE FAGANCredential: IDC
Location Address4077 32ND ST, APT 8San Diego, CA 92104-2080
Mailing Address4077 32nd St, Apt 8San Diego, CA 92104-2080 · (678) 764-4067
Phone(678) 764-4067
Sole ProprietorYes
Enumeration DateMay 9, 2013
✔ NPI 1104261726 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMilitary Health Care ProviderOther Service Providers
Taxonomy Code171000000X
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
4077 32ND ST, San Diego, CA 92104
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Other Identifiers 1

Other1710-1002XIdc

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Marie Fagan's NPI number?

The NPI number for Marie Fagan is 1104261726. It was assigned to this individual provider in the NPPES registry on May 9, 2013.

Where is Marie Fagan located?

Marie Fagan practices at 4077 32nd St Apt 8, San Diego, CA 92104. The listed phone number is (678) 764-4067.

What is Marie Fagan's specialty?

The primary specialty registered for this NPI is Military Health Care Provider with taxonomy code 171000000X.

When was this NPI record last updated?

The NPPES record for Marie Fagan was last updated on May 9, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.