MEDICARE: GEORGE THOMAS STEVENS IV IDC (NAVY)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1962614560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE THOMAS STEVENS IV IDC (NAVY)

Provider Business Mailing Address
First Line	:	3330 TARAWA RD BLDG 327
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5078
Country	:	US
Telephone Number	:	619-437-5139
Fax Number	:	619-437-5099

Provider Business Practice Location Address
First Line	:	3330 TARAWA RD BLDG 327
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5078
Country	:	US
Telephone Number	:	619-437-5139
Fax Number	:	619-437-5099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1639398266 — MR. LEONARD FLAGG H.H.P., M.T.
Practice Location Address:

5078 BEECH ST
SAN DIEGO, CA
92102-2612

Practice Phone: 619-261-9996
Practice Fax:

1356856694 — ALI SHOOSHTARI ALAVI MD
Practice Location Address:

5078 MANOR RIDGE LN
SAN DIEGO, CA
92130-2896

Practice Phone: 949-562-4039
Practice Fax: 949-239-7799

1528886967 — ALPA MEDICAL GROUP
Practice Location Address:

5078 MANOR RIDGE LN
SAN DIEGO, CA
92130-2896

Practice Phone: 858-630-8940
Practice Fax: 949-239-7799

1730492091 — PATTI MUN DE LEON-PRIETO LCSW
Practice Location Address:

4210 AMOS POLLARD
SAN ANTONIO, TX
78253-5078

Practice Phone: 210-570-6407
Practice Fax:

1902281983 — MR. DYLAN SCOTT TAYAG LCSW
Practice Location Address:

27431 SAN BERNARDINO AVE APT 73
REDLANDS, CA
92374-5078

Practice Phone: 760-230-3752
Practice Fax:

Directions to “ GEORGE THOMAS STEVENS IV IDC (NAVY)” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.