Provider Demographics
NPI:1396970711
Name:DAVIES, JUSTIN (HMC/IDC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:DAVIES
Suffix:
Gender:M
Credentials:HMC/IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL HOSPITAL CAMP PENDLETON
Mailing Address - Street 2:PO BOX 555191
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5191
Mailing Address - Country:US
Mailing Address - Phone:760-725-1488
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL CAMP PENDLETON
Practice Address - Street 2:BOX 555191
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5191
Practice Address - Country:US
Practice Address - Phone:760-725-1488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman