Healthcare Provider Details

I. General information

NPI: 1760546576
Provider Name (Legal Business Name): NAVAL MEDICAL CENTER SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR SUITE 202
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

10935 CAMINITO ARBOLES
SAN DIEGO CA
92131-3563
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7302
  • Fax:
Mailing address:
  • Phone: 858-880-3295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number9711
License Number StateCA

VIII. Authorized Official

Name: DR. PRESTON GABLE
Title or Position: DEPARTMENT HEAD
Credential: MD
Phone: 619-532-7302