person
Mr. Larry Odell Neely, IDC
Military Health Care Provider in San Diego, California
NPI 1568719821

Larry Odell Neely is a Military Health Care Provider based in San Diego, CA. Larry Odell Neely practices in San Diego, CA and has the professional credentials of IDC. The NPI Number for Larry Odell Neely is 1568719821 and holds a License No. (California).

The current practice location address for Larry Odell Neely is 34101 Farenholt Ave Bldg 14, San Diego, CA and can be reached out via phone at 619-532-6195. You can also correspond with Larry Odell Neely through the mailing address at 10125 BORDELON ST, SAN DIEGO, CA - 92124-3204 (mailing address contact number: 858-444-0108).

Location: 34101 Farenholt Ave Bldg 14, San Diego, CA, 92124-3204
person
Provider Profile Details
NPI Number
1568719821
Provider Name
Larry Odell Neely
Credential
IDC
Provider Entity Type
Individual
Gender
Male
Address
34101 Farenholt Ave Bldg 14, San Diego, CA, 92124-3204
Phone Number
619-532-6195
Fax Number
Provider Enumeration Date
08/06/2012
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
34101 Farenholt Ave Bldg 14
City
State
Zip
92134-5291
Phone Number
619-532-6195
Fax Number
person
Provider Business Mailing Address Details
Address
34101 Farenholt Ave Bldg 14
City
State
Zip
92134-5291
Phone Number
619-532-6195
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
-
Taxonomy
License No.
()
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
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