| Doctor Name: | KYLE MOMBELL |
| NPI Number: | 1154700862 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | |
| Business Practice Address: | Nmc San Diego 34800 Bob Wilson Dr Ste 112 San Diego, CA - 921345000 |
| Business Phone Number: | 6195329795 |
| Business Fax Number: | 6195327508 |
| Mailing Address: | Nmc San Diego 34800 Bob Wilson Dr, Ste 112 SAN DIEGO |
| State: | CA |
| Postal Code: | 921345000 |
| Phone Number: | 6195329795 |
| Fax Number: | 6195327508 |
| NPI Enumeration Date: | 05/27/2015 |
| NPI Last Update Date: | 06/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |