Provider Demographics
NPI:1568905511
Name:UNITED STATES NAVY
Entity Type:Organization
Organization Name:UNITED STATES NAVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT DUTY CORPSMAN
Authorized Official - Prefix:
Authorized Official - First Name:MIKHAILPIETRO
Authorized Official - Middle Name:ORENA
Authorized Official - Last Name:DRILON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-215-1564
Mailing Address - Street 1:10614 PINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-1513
Mailing Address - Country:US
Mailing Address - Phone:818-353-8277
Mailing Address - Fax:
Practice Address - Street 1:1ST MARDIV 7TH MARINE REG
Practice Address - Street 2:NAVPERS OFFICE BLDG 1525
Practice Address - City:29 PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278-8150
Practice Address - Country:US
Practice Address - Phone:760-830-5707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Single Specialty