Healthcare Provider Details

I. General information

NPI: 1407823479
Provider Name (Legal Business Name): NAVAL EXPEDITIONARY MEDICAL TRAINING INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632044 SAN MATEO RD NOMI DET NEMTI BOX 555223
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

4918 SEASCAPE DR
OCEANSIDE CA
92057-6253
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-7121
  • Fax:
Mailing address:
  • Phone: 760-725-7121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: ELIZABETH A BREZA
Title or Position: OFFICER IN CHARGE
Credential: NC
Phone: 760-725-7121