NAVAL MEDICAL CENTER SAN DIEGO (NPI# 1063766459) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063766459 |
| Entity Type | Organization |
| Organization Name | NAVAL MEDICAL CENTER SAN DIEGO |
| Practice Address |
11770 Bernardo Plaza Ct Suite 250 San Diego CA 92128-2422 |
| Mailing Address |
34520 Bob Wilson Dr Suite 20 San Diego CA 92134-2098 |
| Practice Telephone | 6195328407 |
| Practice Fax Number | 6195326260 |
| Mailing Telephone | 6195328407 |
| Mailing Fax Number | 6195326260 |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2017-11-24 |
| Authorized Official Name | WILLIAM M CONDON (BUMED UBO) |
| Authorized Official Telephone | 2404013643 |
| Is Organization Subpart | Y |
| Parent Organization Name | NAVAL MEDICAL CENTER SAN DIEGO |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2137760 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700245099 | Naval Medical Center San Diego | Pharmacy | Mcas Miramar Exchange Pharmacy, Bldg 2660, San Diego, CA 92126 | 2016-02-16 |
| 1265846323 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | 34800 Bob Wilson Dr Ste 3, San Diego, CA 92134-1003 | 2014-06-17 |
| 1134569924 | Naval Medical Center San Diego | Substance Abuse Rehabilitation Facility | 500 Sylvester Rd, Bldg 500, San Diego, CA 92111 | 2013-06-26 |
| 1508036112 | Naval Medical Center San Diego | Military Hospital | 550 15th Street Unit 709, San Diego, CA 92101 | 2008-03-11 |
| 1982802179 | Naval Medical Center San Diego | Clinic/Center | 120 Town Center Pkwy, Santee, CA 92071-5801 | 2007-07-10 |
| 1205998101 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | 34800 Bob Wilson Dr Ste 113, San Diego, CA 92134-1113 | 2006-12-15 |
| 1407927494 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | 110 Bldg B Town Center Pkwy, Santee, CA 92134-1098 | 2006-11-13 |
| 1821197872 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | Bldg 601, San Diego, CA 92135 | 2006-09-22 |
| 1720187776 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | 523 S 8th St, Bldg 523, El Centro, CA 92243 | 2006-09-22 |
| 1639278682 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | Bouganville Rd, Bldg 506, San Diego, CA 92155-0001 | 2006-09-22 |
| Street Address |
11770 BERNARDO PLAZA CT SUITE 250 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92128-2422 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457351439 | Eloise R. Johnston & Associates | Speech-Language Pathologist | 11770 Bernardo Plaza Ct, Suite 208, San Diego, CA 92128-2422 | 2005-07-29 |
| 1679189278 | Tianna M Duquette | Behavioral Analyst | 11770 Bernardo Plaza Ct, San Diego, CA 92128-2422 | 2020-09-18 |
| 1538793294 | Juzenne Cruz | Behavior Technician | 11770 Bernardo Plaza Ct, San Diego, CA 92128-2422 | 2020-03-02 |
| 1205489887 | Sydney Selecky | Behavior Technician | 11770 Bernardo Plaza Ct, San Diego, CA 92128-2422 | 2019-07-22 |
| 1184187478 | Arianna Spata | Behavior Technician | 11770 Bernardo Plaza Ct, San Diego, CA 92128-2422 | 2019-04-12 |
| 1588127880 | Myshayla Fryer | Behavior Technician | 11770 Bernardo Plaza Ct, San Diego, CA 92128-2422 | 2019-04-12 |
| 1427511211 | Denae Padilla | Behavior Technician | 11770 Bernardo Plaza Ct, San Diego, CA 92128-2422 | 2019-04-09 |
| 1700348612 | Sonja Sunny Cash | Behavior Technician | 11770 Bernardo Plaza Ct, San Diego, CA 92128-2422 | 2019-04-01 |
| 1336600691 | Guadalupe Ramirez | Behavior Technician | 11770 Bernardo Plaza Ct, San Diego, CA 92128-2422 | 2019-03-28 |
| 1770044026 | Shauna Davis | Behavior Technician | 11770 Bernardo Plaza Ct, San Diego, CA 92128-2422 | 2019-03-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518585371 | Alicia Ford | Behavior Technician | 1170 Bernardo Plaza Court, Suite 350, San Diego, CA 92128 | 2020-07-08 |
| 1164087573 | Madeleine White | Dietitian, Registered | 16685 W Bernardo Dr, Suite 121, San Diego, CA 92128 | 2019-05-01 |
| 1053807677 | Joele Ghosn | Speech-Language Pathologist | 11838 Bernardo Plaza Ct #110, San Diego, CA 92128 | 2018-07-06 |
| 1376034348 | Eddie Reginald Burston II | In Home Supportive Care | 12727 Camino Emparrado, San Diego, CA 92128 | 2018-05-24 |
| 1336659218 | Ryan Fong | Physician Assistant | 15004 Innovation Drive (s97), San Diego, CA 92128 | 2017-10-05 |
| 1508316191 | Araceli Flores | Behavioral Analyst | 15737 Innovation Dr, Suite 200, San Diego, CA 92128 | 2016-10-07 |
| 1003283961 | Katherine Dishner | Hearing Instrument Specialist | 16766 Bernardo Center Dr Ste 206, San Diego, CA 92128 | 2015-08-27 |
| 1205212586 | Mobilia Dmd Inc. | Point of Service | 12405 Rancho Bernardo Rd., San Diego, CA 92128 | 2015-08-10 |
| 1346623634 | Angela Christine Storck-petersen | Dietitian, Registered | 11768 Caminito Corriente, San Diego, CA 92128 | 2015-07-04 |
| 1134526874 | Breeana Rose Lancaster | Speech-Language Pathologist | 11838 Bernardo Plaza Ct. Suite 110, Kids Therapy Associates, San Diego, CA 92128 | 2014-11-24 |
| Find all providers in zip 92128 | ||||
| Taxonomy Code | 332000000X |
| Grouping | Suppliers |
| Classification | Military/U.S. Coast Guard Pharmacy |
| A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: new; 7/1/2006: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265846323 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | 34800 Bob Wilson Dr Ste 3, San Diego, CA 92134-1003 | 2014-06-17 |
| 1205998101 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | 34800 Bob Wilson Dr Ste 113, San Diego, CA 92134-1113 | 2006-12-15 |
| 1821197872 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | Bldg 601, San Diego, CA 92135 | 2006-09-22 |
| 1639278682 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | Bouganville Rd, Bldg 506, San Diego, CA 92155-0001 | 2006-09-22 |
| 1912006966 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | 19875 Mitscher Way, Bldg 2495, San Diego, CA 92145-5103 | 2006-09-22 |
| 1730288788 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | 25000 Guadal Canal Rd, Bldg 256, San Diego, CA 92140 | 2006-09-22 |
| 1003915059 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | 32 Nd St Navy Exchange, Bldg 3187, San Diego, CA 92136-0001 | 2006-09-22 |
| 1750480794 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | Business Office Code Rbe, 34520 Bob Wilson Dr Ste 20, San Diego, CA 92134-2020 | 2006-09-22 |
| 1962501924 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | Naval Medical Centerpharmacy Dept, 34800 Bob Wilson Drive, San Diego, CA 92134-0001 | 2006-09-22 |
| 1366856437 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | 34800 Bob Wilson Dr Ste 1, San Diego, CA 92134-5000 | 2014-06-17 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.