Healthcare Provider Details

I. General information

NPI: 1598971749
Provider Name (Legal Business Name): DUSTIN ADAMS IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL CAMP PENDLETON 52 AREA BRANCH MEDICAL CLINIC
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

1712 PROMENADE CIR
VISTA CA
92083-6169
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-7200
  • Fax:
Mailing address:
  • Phone: 760-414-9826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: