Provider Demographics
NPI:1801978952
Name:NACC PORT HUNEME
Entity type:Organization
Organization Name:NACC PORT HUNEME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OIC
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:805-982-6370
Mailing Address - Street 1:1485 LAS POSITAS PL
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NACC
Practice Address - Street 2:162 FIRST STREET BUILDING 1402
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93043-0001
Practice Address - Country:US
Practice Address - Phone:805-982-6342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty