Healthcare Provider Details

I. General information

NPI: 1326015652
Provider Name (Legal Business Name): USS ESSEX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS ESSEX (LHD 2)
FPO AP
96643
JP

IV. Provider business mailing address

PSC 476 BOX 1147
FPO AP
96322
JP

V. Phone/Fax

Practice location:
  • Phone: 810956503365
  • Fax:
Mailing address:
  • Phone: 81956503365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name: REYNALDO DINULONG
Title or Position: LCPO
Credential: IDC, BSN, RN
Phone: 808-653-3365