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General NPI Number Information
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NPI Number | 1790056372
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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 | 01/13/2012
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 3423 GUADALCANAL RD BLDG 401 2ND DECK
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City | SAN DIEGO
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State | CA
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Zip | 92155-5000
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Country | US
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Telephone | 619-537-1304
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Fax |
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Provider Business Mailing Address
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Address Line | 3423 GUADALCANAL RD BLDG 401 2ND DECK
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City | SAN DIEGO
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State | CA
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Zip | 92155-5000
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Country | US
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Telephone | 619-537-1304
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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 | NICHOLAS SARKODIE ACHEAMPONG
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Credential | IDC
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Telephone | 619-537-1335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number |
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License Number State |
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