Provider Demographics
NPI:1326015652
Name:USS ESSEX
Entity Type:Organization
Organization Name:USS ESSEX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPO
Authorized Official - Prefix:
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DINULONG
Authorized Official - Suffix:
Authorized Official - Credentials:IDC, BSN, RN
Authorized Official - Phone:808-653-3365
Mailing Address - Street 1:PSC 476 BOX 1147
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96322
Mailing Address - Country:JP
Mailing Address - Phone:8195-650-3365
Mailing Address - Fax:
Practice Address - Street 1:USS ESSEX (LHD 2)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96643
Practice Address - Country:JP
Practice Address - Phone:81095-650-3365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Single Specialty