Healthcare Provider Details

I. General information

NPI: 1972916740
Provider Name (Legal Business Name): NAVAL HOSPITAL CAMP PENDLETON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 AREA BRANCH MEDICAL 540450 BASILONE RD
CAMP PENDELTON CA
92055
US

IV. Provider business mailing address

34520 BOB WILSON DR STE 20
SAN DIEGO CA
92134-2098
US

V. Phone/Fax

Practice location:
  • Phone: 760-763-2421
  • Fax: 760-725-0232
Mailing address:
  • Phone: 619-532-8400
  • Fax: 805-989-3936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. HECTOR MORALES
Title or Position: CHIEF DHA POSC
Credential:
Phone: 210-536-6650