Healthcare Provider Details

I. General information

NPI: 1316113665
Provider Name (Legal Business Name): NAVAL HOSPITAL CAMP PENDLETON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

H100 SANTA MARGARITA ROAD
CAMP PENDLETON CA
92058
US

IV. Provider business mailing address

BLDG H100 SANTA MARGARITA ROAD
CAMP PENDLETON CA
92058-0000
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1495
  • Fax:
Mailing address:
  • Phone: 760-725-1495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE JOVELLANOS
Title or Position: MEDICAL LABORATORY TECHNICIAN
Credential:
Phone: 760-725-1495