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General NPI Number Information
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NPI Number | 1679824585
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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 | 10/02/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | BLDG 14137
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City | CAMP PENDLETON
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State | CA
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Zip | 92055-5697
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Country | US
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Telephone | 760-763-4028
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 555697 COMBAT LOGISTICS BATTALION 11
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City | CAMP PENDLETON
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State | CA
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Zip | 92055-5697
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Country | US
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Telephone | 760-763-4028
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MS. CHELSEA LAUREN MCLEAN
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Credential | PA-C, M.H.S
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Telephone | 434-960-2638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2865M2000X
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Taxonomy Name | Military General Acute Care Hospital
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License Number | 1096852
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License Number State | PA
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