Healthcare Provider Details

I. General information

NPI: 1326905415
Provider Name (Legal Business Name): WARREN GORMLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 555584
CAMP PENDLETON CA
92055-5584
US

IV. Provider business mailing address

3853 SAN RAMON DR APT 224
OCEANSIDE CA
92057-7225
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-8912
  • Fax:
Mailing address:
  • Phone: 509-423-1896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number04250694WG
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: