MEDICARE: NAVAL MEDICAL CENTER SAN DIEGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1417197591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAVAL MEDICAL CENTER SAN DIEGO

Provider Business Mailing Address
First Line	:	2446 TRIDENT WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5494
Country	:	US
Telephone Number	:	619-437-0777
Fax Number	:	619-437-5248

Provider Business Practice Location Address
First Line	:	2446 TRIDENT WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5494
Country	:	US
Telephone Number	:	619-437-0777
Fax Number	:	619-437-5248

Authorized Official
Title or Position	:	PROVIDER
Name	:	MR. RANDY N LIGHTCAP
Credential	:	IDC
Telephone Number	:	619-437-0777

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	03/02/2009

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1740266576 — DR. ERIC G POTTERAT PH.D.
Practice Location Address:

NAVAL SPECIAL WARFARE CENTER , 2446 TRIDENT WAY
SAN DIEGO, CA
92155-5494

Practice Phone: 619-437-3652
Practice Fax:

1497726525 — MR. MARIO OSWALDO MARTIN IDC
Practice Location Address:

2446 TRIDENT WAY
SAN DIEGO, CA
92155-5494

Practice Phone: 619-437-0777
Practice Fax:

1598736449 — MR. MICHAEL TAD GARRITSON IDC
Practice Location Address:

2446 TRIDENT WAY , MEDICAL CLINIC
SAN DIEGO, CA
92155-5494

Practice Phone: 619-437-0777
Practice Fax:

1548232697 — MR. RAFAEL PEREZ JR. PA-C
Practice Location Address:

2446 TRIDENT WAY
SAN DIEGO, CA
92155-5494

Practice Phone: 619-437-0777
Practice Fax:

1619372422 — NATASHIA LIBBY
Practice Location Address:

2446 TRIDENT WAY
SAN DIEGO, CA
92155-5494

Practice Phone: 619-537-2055
Practice Fax:

Directions to “NAVAL MEDICAL CENTER SAN DIEGO ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.