Individual
LAUREL SPACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-5000
(650) 793-7448
Mailing address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-5000
(650) 793-7448
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
0101283764
VA
Other
Enumeration date
03/07/2023
Last updated
02/03/2025
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