Healthcare Provider Details

I. General information

NPI: 1023356110
Provider Name (Legal Business Name): NAVY MEDICAL CENTER SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 CUSHING RD
SAN DIEGO CA
92106-6173
US

IV. Provider business mailing address

780 CAMINO DE LA REINA APT 244
SAN DIEGO CA
92108-3230
US

V. Phone/Fax

Practice location:
  • Phone: 619-524-6484
  • Fax:
Mailing address:
  • Phone: 703-851-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number1
License Number StateVA

VIII. Authorized Official

Name: DR. KRISTA GREENE
Title or Position: OPTOMETRIST
Credential: O.D
Phone: 703-851-1975