Marie Louise Fagan, IDC

Primary specialty

Military Health Care ProviderTaxonomy code 171000000X

Practice address

4077 32ND St
Apt 8
San Diego, CA 92104-2080

Phone

(678) 764-4067

NPI assigned

May 9, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1368057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368057600000",
    "number": "1104261726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4077 32ND ST",
            "address_2": "APT 8",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921042080",
            "telephone_number": "678-764-4067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4077 32ND ST",
            "address_2": "APT 8",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921042080",
            "telephone_number": "678-764-4067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "MARIE",
        "middle_name": "LOUISE",
        "credential": "IDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-09",
        "last_updated": "2013-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDC",
            "identifier": "1710-1002X",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sameerah Abdo Fadel
• Anna Fadem, MFTI
• Nancy Fader, MFT
• Brian T Fagan, M.D.
• Janet M Fagan, LCSW
• Philip Fagan III, MD
• Sara Kathleen Fagan, PA-C
• Sherilyn Lydia Fagan
• Daniel H Fagerson, M.D.
• Nilofar Faghihnia, D.P.M.

• Military Health Care Provider in San Diego, CA
• Providers in San Diego, CA by specialty
• Military Health Care Provider in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.