Provider Demographics
NPI:1508036112
Name:NAVAL MEDICAL CENTER SAN DIEGO
Entity Type:Organization
Organization Name:NAVAL MEDICAL CENTER SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCALISE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:703-740-7435
Mailing Address - Street 1:34800 BOB WILSON DRIVE
Mailing Address - Street 2:NAVAL MEDICAL CENTER SAN DIEGO
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-5000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 15TH STREET UNIT 709
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101
Practice Address - Country:US
Practice Address - Phone:703-740-7435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital