1568905511 NPI number — UNITED STATES NAVY

Table of content: (NPI 1568905511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568905511 NPI number — UNITED STATES NAVY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED STATES NAVY
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:
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:
1568905511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10614 PINEWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUJUNGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91042-1513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-353-8277
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1ST MARDIV 7TH MARINE REG
Provider Second Line Business Practice Location Address:
NAVPERS OFFICE BLDG 1525
Provider Business Practice Location Address City Name:
29 PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92278-8150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-830-5707
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/23/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DRILON
Authorized Official First Name:
MIKHAILPIETRO
Authorized Official Middle Name:
ORENA
Authorized Official Title or Position:
INDEPENDENT DUTY CORPSMAN
Authorized Official Telephone Number:
626-215-1564

Provider Taxonomy Codes

  • Taxonomy code: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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