Healthcare Provider Details

I. General information

NPI: 1134569924
Provider Name (Legal Business Name): NAVAL MEDICAL CENTER SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SYLVESTER RD BLDG 500
SAN DIEGO CA
92111
US

IV. Provider business mailing address

500 SYLVESTER RD BLDG 500
SAN DIEGO CA
92106
US

V. Phone/Fax

Practice location:
  • Phone: 619-553-0354
  • Fax: 619-553-8945
Mailing address:
  • Phone: 619-553-0354
  • Fax: 619-553-8945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License NumberLCS 23698
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberLCS 23698
License Number StateCA

VIII. Authorized Official

Name: MRS. FUERTE RHODA
Title or Position: MEDICAL STAFF SERVICES
Credential:
Phone: 619-532-6684