=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750778569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAVAL HOSPITAL TWENTYNINE PALMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2015
-----------------------------------------------------
Last Update Date | 03/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 ADMINISTRATION CIR STOP 1311 BLDG 1403
-----------------------------------------------------
City | RIDGECREST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93555-6104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-939-8001
-----------------------------------------------------
Fax | 619-939-2911
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 788250
-----------------------------------------------------
City | TWENTYNINE PALMS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92278-8250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-532-8400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF DHA POSC
-----------------------------------------------------
Name | HECTOR MORALES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-536-6650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332000000X
-----------------------------------------------------
Taxonomy Name | Military/U.S. Coast Guard Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------