Healthcare Provider Details

I. General information

NPI: 1568905511
Provider Name (Legal Business Name): UNITED STATES NAVY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST MARDIV 7TH MARINE REG NAVPERS OFFICE BLDG 1525
29 PALMS CA
92278-8150
US

IV. Provider business mailing address

10614 PINEWOOD AVE
TUJUNGA CA
91042-1513
US

V. Phone/Fax

Practice location:
  • Phone: 760-830-5707
  • Fax:
Mailing address:
  • Phone: 818-353-8277
  • 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: MIKHAILPIETRO ORENA DRILON
Title or Position: INDEPENDENT DUTY CORPSMAN
Credential:
Phone: 626-215-1564