1093127789 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 1093127789 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:
1093127789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/23/2024
NPI Reactivation Date:
06/29/2026

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34520 BOB WILSON DR
Provider Second Line Business Mailing Address:
STE 20
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92134-2098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-532-8400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MCMWTC
Provider Second Line Business Practice Location Address:
BLDG 3005 SR 108
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-932-1619
Provider Business Practice Location Address Fax Number:
760-932-1623
Provider Enumeration Date:
05/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MORALES
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF DHA POSC
Authorized Official Telephone Number:
210-536-6650

Provider Taxonomy Codes

  • Taxonomy code: 332000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2145966 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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