Provider Demographics
NPI:1750365003
Name:USAF
Entity type:Organization
Organization Name:USAF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ELEMENT CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MARIA DE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEBRON
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:707-423-7977
Mailing Address - Street 1:1300 BURTON DR
Mailing Address - Street 2:APT 131
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3526
Mailing Address - Country:US
Mailing Address - Phone:707-635-8801
Mailing Address - Fax:
Practice Address - Street 1:101 BODIN CIR
Practice Address - Street 2:TRAVIS AFB
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94535-1809
Practice Address - Country:US
Practice Address - Phone:707-423-7899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00726282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital