Provider Demographics
NPI:1134569924
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:MEDICAL STAFF SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:FUERTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-532-6684
Mailing Address - Street 1:500 SYLVESTER RD
Mailing Address - Street 2:BLDG 500
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106
Mailing Address - Country:US
Mailing Address - Phone:619-553-0354
Mailing Address - Fax:619-553-8945
Practice Address - Street 1:500 SYLVESTER RD
Practice Address - Street 2:BLDG 500
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111
Practice Address - Country:US
Practice Address - Phone:619-553-0354
Practice Address - Fax:619-553-8945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF DEFENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 23698324500000X, 2865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility