Healthcare Provider Details

I. General information

NPI: 1720187776
Provider Name (Legal Business Name): NMC SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 S 8TH ST BLDG 523
EL CENTRO CA
92243
US

IV. Provider business mailing address

34520 BOB WILSON DR STE 20 CAPTAIN OLAF NAUGEN
SAN DIEGO CA
92134-2020
US

V. Phone/Fax

Practice location:
  • Phone: 760-339-2631
  • Fax: 619-532-5898
Mailing address:
  • Phone: 760-339-2631
  • Fax: 619-532-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: CHIEF DHA PASS
Credential:
Phone: 210-536-6650