Healthcare Provider Details

I. General information

NPI: 1902123243
Provider Name (Legal Business Name): 60TH MEDGRP-TRAVIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 CABRILLO ST A-102
MONTEREY CA
93944-3201
US

IV. Provider business mailing address

473 CABRILLO ST A-102
MONTEREY CA
93944-3201
US

V. Phone/Fax

Practice location:
  • Phone: 831-242-5382
  • Fax: 831-242-5809
Mailing address:
  • Phone: 831-242-5382
  • Fax: 831-242-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
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