Healthcare Provider Details

I. General information

NPI: 1821281148
Provider Name (Legal Business Name): UNITED STATES NAVY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 827 BOX 123
FPO AE
09617
IT

IV. Provider business mailing address

PSC 827 BOX 123
FPO AE
09617
IT

V. Phone/Fax

Practice location:
  • Phone: 011393182558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number593474
License Number StateCA

VIII. Authorized Official

Name: MR. RICHARD WARREN SCHULZ
Title or Position: UNIT MANAGER
Credential: RN
Phone: 011393463182558