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General NPI Number Information
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NPI Number | 1538120068
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Entity Type | Organization
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Legal Business Name | U.S. NAVY
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Dates
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Enumeration Date | 04/02/2006
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 34800 BOB WILSON DR
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City | SAN DIEGO
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State | CA
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Zip | 92134-1098
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Country | US
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Telephone | 619-245-1693
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Fax |
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Provider Business Mailing Address
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Address Line | 2240 SPRING OAK WAY
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City | SAN DIEGO
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State | CA
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Zip | 92139-3922
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Country | US
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Telephone | 619-475-1100
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Fax |
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Authorized Official
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Title or Position | INDEPENDENT DUTY CORPSMAN
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Name | BENEDICTO VICENCIO MANALANSAN
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Credential |
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Telephone | 619-475-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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