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General NPI Number Information
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NPI Number | 1306395280
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Entity Type | Organization
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Legal Business Name | UNITED STATES NAVY
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Dates
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Enumeration Date | 10/03/2016
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Last Update Date | 10/03/2016
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Provider Practice Location Address
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Address Line | BUILDING H 2005 KNIGHT LANE NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS
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City | JACKSONVILLE
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State | FL
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Zip | 32212-0140
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Country | US
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Telephone | 760-725-3213
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Fax |
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Provider Business Mailing Address
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Address Line | 853 VALLEY AVE
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City | SOLANA BEACH
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State | CA
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Zip | 92075-2492
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Country | US
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Telephone | 631-948-3006
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Fax |
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Authorized Official
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Title or Position | COMMANDING OFFICER
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Name | DR. PETER RUOCCO
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Credential |
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Telephone | 760-725-5208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7136-15
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License Number State | WI
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