Healthcare Provider Details

I. General information

NPI: 1942554373
Provider Name (Legal Business Name): UNITED STATES NAVY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

H100 SANTA MARGARITA ROAD ATTENTION: CODE 00QM
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

H100 SANTA MARGARITA ROAD ATTENTION: CODE 00QM
CAMP PENDLETON CA
92055-5191
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-2903
  • Fax: 760-725-1267
Mailing address:
  • Phone: 760-725-2903
  • Fax: 760-725-1267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. TOM COLGAN
Title or Position: QUALITY MANAGEMENT DEPARTMENT
Credential:
Phone: 760-725-8882