=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396732871
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NMC SAN DIEGO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2005
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34800 BOB WILSON DR
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92134-1098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-532-6397
-----------------------------------------------------
Fax | 619-532-6645
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34800 BOB WILSON DR
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92134-1098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-532-6397
-----------------------------------------------------
Fax | 619-532-6645
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | UBO MANAGER
-----------------------------------------------------
Name | MARYANN MARQUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-532-5083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2865M2000X
-----------------------------------------------------
Taxonomy Name | Military General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------