Provider Demographics
NPI:1538120068
Name:U.S. NAVY
Entity Type:Organization
Organization Name:U.S. NAVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT DUTY CORPSMAN
Authorized Official - Prefix:
Authorized Official - First Name:BENEDICTO
Authorized Official - Middle Name:VICENCIO
Authorized Official - Last Name:MANALANSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-475-1100
Mailing Address - Street 1:2240 SPRING OAK WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-3922
Mailing Address - Country:US
Mailing Address - Phone:619-475-1100
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-245-1693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-02
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710I1002XOtherINDEPENDENT DUTY CORPSMAN