Healthcare Provider Details

I. General information

NPI: 1669881140
Provider Name (Legal Business Name): NAVAL HOSPITAL CAMP PENDLETON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE ATTENTION: CODE 00QM
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

200 MERCY CIRCLE ATTENTION: CODE 00QM
CAMP PENDLETON CA
92055-5191
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-4015
  • Fax:
Mailing address:
  • Phone: 760-725-4015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number829601
License Number StateCA

VIII. Authorized Official

Name: TOM COLGAN
Title or Position: CREDENTIALING OFFICER
Credential:
Phone: 760-725-8882