Provider Demographics
NPI:1376878876
Name:NAVAL HOSPITAL BALBOA
Entity Type:Organization
Organization Name:NAVAL HOSPITAL BALBOA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:39/STUDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-532-5829
Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:BLDG 1 SUITE 207
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1207
Mailing Address - Country:US
Mailing Address - Phone:619-532-5829
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:BLDG 1 SUITE 207
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1207
Practice Address - Country:US
Practice Address - Phone:619-532-5829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA39OtherMEDI-CAL/MEDICARE