Healthcare Provider Details

I. General information

NPI: 1306184692
Provider Name (Legal Business Name): NAVAL MEDICAL CENTER SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 KNIGHT LANE BLDG H NAVY MEDICINE SUPPORT COMMAND, ATTN: MEDICAL STAFF SERV
JACKSONVILLE FL
32212-0140
US

IV. Provider business mailing address

303 WOODMEADOW LN
RAMONA CA
92065-5043
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-6684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number90496
License Number StateCA

VIII. Authorized Official

Name: JULIE SPRING
Title or Position: CRNA
Credential:
Phone: 619-952-3510