Individual
THEO NEAL KIRKLAND III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5709 WAVERLY AVE, LA JOLLA, CA 92037-7336
(858) 752-7989
(858) 459-7471
Mailing address
5709 WAVERLY AVE, LA JOLLA, CA 92037-7336
(858) 752-7989
(858) 459-7171
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G39331
CA
207RI0200X
Infectious Disease Physician
Primary
G39331
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G393310
—
CA
Enumeration date
08/11/2006
Last updated
03/02/2022
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