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General NPI Number Information
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NPI Number | 1568905511
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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 | 11/23/2016
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 1ST MARDIV 7TH MARINE REG NAVPERS OFFICE BLDG 1525
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City | 29 PALMS
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State | CA
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Zip | 92278-8150
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Country | US
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Telephone | 760-830-5707
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Fax |
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Provider Business Mailing Address
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Address Line | 10614 PINEWOOD AVE
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City | TUJUNGA
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State | CA
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Zip | 91042-1513
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Country | US
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Telephone | 818-353-8277
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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 | MIKHAILPIETRO ORENA DRILON
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Credential |
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Telephone | 626-215-1564
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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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