Provider Demographics
NPI:1801333992
Name:US NAVY
Entity type:Organization
Organization Name:US NAVY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RDH
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-381-8749
Mailing Address - Street 1:1752 TRELLIS WAY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915
Mailing Address - Country:US
Mailing Address - Phone:224-381-8749
Mailing Address - Fax:
Practice Address - Street 1:1752 TRELLIS WAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915
Practice Address - Country:US
Practice Address - Phone:224-381-8749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital