Healthcare Provider Details

I. General information

NPI: 1033506431
Provider Name (Legal Business Name): NAVAL HOSPITAL CAMP PENDLETON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 1ST ST BLDG 1402
PORT HUENEME CA
93043
US

IV. Provider business mailing address

34520 BOB WILSON DR STE 20
SAN DIEGO CA
92134-2098
US

V. Phone/Fax

Practice location:
  • Phone: 805-982-6411
  • Fax: 805-982-6095
Mailing address:
  • Phone: 619-532-8400
  • Fax:

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: MR. HECTOR MORALES
Title or Position: NAVY MEDICINE UBO PROGRAM MANAGER
Credential:
Phone: 210-536-6650