Healthcare Provider Details

I. General information

NPI: 1487637930
Provider Name (Legal Business Name): NAVAL MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CENTRAL AVE
PEARL HARBOR HI
96860-4908
US

IV. Provider business mailing address

480 CENTRAL AVE
PEARL HARBOR HI
96860-4908
US

V. Phone/Fax

Practice location:
  • Phone: 808-473-1880
  • Fax:
Mailing address:
  • Phone: 808-473-1880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberMD9534
License Number StateHI

VIII. Authorized Official

Name: DR. JOHN ROCHAT
Title or Position: PHYSICIAN
Credential: MD
Phone: 808-473-1880