1508253907 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 1508253907 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:
POINT MUGU WCC PHCY
Provider Other Organization Name Type Code:
3
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:
1508253907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

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:
1991 PACIFIC RD BRANCH MEDICAL CLN
Provider Second Line Business Practice Location Address:
CODE NC20 NAWS
Provider Business Practice Location Address City Name:
POINT MUGU NAWC
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-989-3922
Provider Business Practice Location Address Fax Number:
805-982-3936
Provider Enumeration Date:
04/23/2015

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" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2151512 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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