Healthcare Provider Details

I. General information

NPI: 1902153828
Provider Name (Legal Business Name): NAVAL MEDICAL CENTER SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

7860 WESTSIDE DRIVE #308
SAN DIEGO CA
92108
US

V. Phone/Fax

Practice location:
  • Phone: 619-794-4459
  • Fax:
Mailing address:
  • Phone: 630-300-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIN SHARI BAILEY
Title or Position: GENERAL PRACTICE RESIDENT
Credential: D.D.S
Phone: 630-300-4567