Provider Demographics
NPI:1386926640
Name:HARDIN, NATHAN (IDC)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:HARDIN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8538 LARKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2050
Mailing Address - Country:US
Mailing Address - Phone:760-586-4884
Mailing Address - Fax:
Practice Address - Street 1:8538 LARKDALE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2050
Practice Address - Country:US
Practice Address - Phone:760-586-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman