Provider Demographics
NPI:1891032413
Name:PICA, JOSEPH JOHN (SFIDC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:PICA
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 FENTON PKWY
Mailing Address - Street 2:106
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-6769
Mailing Address - Country:US
Mailing Address - Phone:619-885-5294
Mailing Address - Fax:
Practice Address - Street 1:NAVAL MOBILE CONSTRUCTION BATTALION THREE
Practice Address - Street 2:NMCB-3 UNIT 25269
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96601-4921
Practice Address - Country:US
Practice Address - Phone:619-885-5294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman