Healthcare Provider Details

I. General information

NPI: 1588728497
Provider Name (Legal Business Name): NAVAL MEDICAL CENTER SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DR.
SAN DIEGO CA
92134-5000
US

IV. Provider business mailing address

10189 PINECASTLE ST
SAN DIEGO CA
92131-2291
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8236
  • Fax:
Mailing address:
  • Phone: 858-578-5667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License NumberRN093310
License Number StateMO

VIII. Authorized Official

Name: LISA LYONS ARNOLD
Title or Position: PEDIATRIC NURSE PRACTITIONER
Credential: PNP
Phone: 619-532-8236