Healthcare Provider Details

I. General information

NPI: 1891032413
Provider Name (Legal Business Name): JOSEPH JOHN PICA SFIDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MOBILE CONSTRUCTION BATTALION THREE NMCB-3 UNIT 25269
FPO AP
96601-4921
US

IV. Provider business mailing address

2555 FENTON PKWY 106
SAN DIEGO CA
92108-6769
US

V. Phone/Fax

Practice location:
  • Phone: 619-885-5294
  • Fax:
Mailing address:
  • Phone: 619-885-5294
  • 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:
Title or Position:
Credential:
Phone: