1366645442 NPI number — NAVAL HOSPITAL CAMP PENDLETON

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366645442 NPI number — NAVAL HOSPITAL CAMP PENDLETON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAVAL HOSPITAL CAMP PENDLETON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366645442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 555191
Provider Second Line Business Mailing Address:
FIN MGMT CODE 0814
Provider Business Mailing Address City Name:
CAMP PENDLETON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92055-5191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-725-1621
Provider Business Mailing Address Fax Number:
760-725-1661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 DISPENSARY ROAD
Provider Second Line Business Practice Location Address:
BLDG 5
Provider Business Practice Location Address City Name:
POINT MUGU
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93042-5017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-1621
Provider Business Practice Location Address Fax Number:
760-725-1661
Provider Enumeration Date:
06/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PETERMAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
H
Authorized Official Title or Position:
BUSINESS OFFICE SUPERVISOR
Authorized Official Telephone Number:
760-725-1661

Provider Taxonomy Codes

  • Taxonomy code: 261QM1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1386604387 . This is a "PARENT FACILITY NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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