Provider Demographics
NPI:1407823479
Name:NAVAL EXPEDITIONARY MEDICAL TRAINING INSTITUTE
Entity Type:Organization
Organization Name:NAVAL EXPEDITIONARY MEDICAL TRAINING INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BREZA
Authorized Official - Suffix:
Authorized Official - Credentials:NC
Authorized Official - Phone:760-725-7121
Mailing Address - Street 1:4918 SEASCAPE DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6253
Mailing Address - Country:US
Mailing Address - Phone:760-725-7121
Mailing Address - Fax:
Practice Address - Street 1:632044 SAN MATEO RD
Practice Address - Street 2:NOMI DET NEMTI BOX 555223
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-7121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABLDG 632044Other632044