Provider Demographics
NPI:1396732871
Name:NMC SAN DIEGO
Entity type:Organization
Organization Name:NMC SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-532-5083
Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1098
Mailing Address - Country:US
Mailing Address - Phone:619-532-6397
Mailing Address - Fax:619-532-6645
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:619-532-6397
Practice Address - Fax:619-532-6645
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NMC SAN DIEGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00DOD3000OtherBS PIN HCFA 1500
CAHSP63228FMedicaid
CAZZT23228FMedicaid
CAZZZH3722ZOtherBS PIN UB92
CA05-20862OtherNCPDP
CAZZZH3722ZOtherBS PIN UB92
CAZZT23228FMedicaid
CA00DOD3000OtherBS PIN HCFA 1500
CAAN1348463OtherDEA