Healthcare Provider Details

I. General information

NPI: 1366856437
Provider Name (Legal Business Name): NMC SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR STE 1
SAN DIEGO CA
92134-5000
US

IV. Provider business mailing address

CO CAPTAIN OLAF HAUGEN 34520 BOB WILSON DR STE 20
SAN DIEGO CA
92134-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8400
  • Fax: 760-763-1024
Mailing address:
  • Phone: 619-532-8400
  • Fax: 619-532-5898

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: HECTOR MORALES
Title or Position: CHIEF DHA POSC
Credential:
Phone: 210-536-6650