NAVAL MEDICAL CENTER SAN DIEGO (NPI# 1124125984) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124125984 |
| Entity Type | Organization |
| Organization Name | NAVAL MEDICAL CENTER SAN DIEGO |
| Other Organization Name | SAN DG 32ND ST NS PHCY |
| Practice Address |
2450 Craven St Bldg 3300 San Diego CA 92136-5599 |
| Practice Telephone | 6195568086 |
| Practice Fax Number | 6195325898 |
| Mailing Telephone | 6195568086 |
| Mailing Fax Number | 6195325898 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-04-04 |
| Authorized Official Name | MR. WILLIAM MICHAEL CONDON (NAVY MEDICINE UBO PROGRAM MANAGER) |
| 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 | 2028517 | 01 |
| Other Name | Type Code |
|---|---|
| SAN DG 32ND ST NS PHCY | Doing Business As Name - Organization |
| 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 |
2450 CRAVEN ST BLDG 3300 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92136-5599 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649276288 | Jennifer Elizabeth Tonge-martin | Nurse Practitioner | 2450 Craven St, San Diego, CA 92136-5599 | 2005-06-27 |
| 1699070987 | Christopher James Tilley | Military Health Care Provider | 2450 Craven St, Bldg 3300, San Diego, CA 92136-5599 | 2011-01-18 |
| 1790089910 | Curtis Ryan Stubblefield | Physician Assistant | 2450 Craven St, Branch Health Clinic Navla Base San Diego, San Diego, CA 92136-5599 | 2011-01-03 |
| 1245542364 | Kimberly Leeniese Chavez | Military Health Care Provider | 2450 Craven St, Branch Medical Clinic Naval Station Bldg 3300, San Diego, CA 92136-5599 | 2010-07-06 |
| 1518118546 | Estrellita Delrosar Edmond | Military Health Care Provider | 2450 Craven St, San Diego, CA 92136 | 2008-10-08 |
| 1043486418 | Joshua David French | Military Health Care Provider | 2450 Craven St, San Diego, CA 92136-5599 | 2008-05-05 |
| 1144496670 | Tijani Bamidele Abdulsalam | Military Health Care Provider | 2450 Craven St, San Diego, CA 92136-5599 | 2008-05-05 |
| 1497927404 | Keren Mireya Lemas | Military Health Care Provider | 2450 Craven St, San Diego, CA 92136-5599 | 2008-03-31 |
| 1013195718 | Carletus M Patrick | Military Health Care Provider | 2450 Craven St, San Diego, CA 92136-5599 | 2008-02-05 |
| 1326132754 | Suriti Kundu | Family Medicine | 2450 Craven St, Branch Medical Clinic Naval Base, San Diego, CA 92136-5599 | 2006-10-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467930164 | Alexa Clifton | Student in an Organized Health Care Education/Training Program | 2525 Callagan Hwy, Fpo, AA 92136 | 2018-08-03 |
| 1235501321 | Family Optometric Associates of California, Inc. | Optometrist | 2260 Callahan Hwy, Bldg 3187-a, San Diego, CA 92136 | 2015-10-28 |
| 1457720427 | Andres Bargados Santamaria IIi | Military Health Care Provider | 116 Cummings Rd, San Diego, CA 92136 | 2015-09-21 |
| 1932470374 | Robert Bishop Beedles Jr. | Military Health Care Provider | 3380 Sturtevant St, Bldg 57 Second Floor, San Diego, CA 92136 | 2012-01-17 |
| 1083771877 | Brianna Leigh Rupp | General Practice | Uss Tarawa Lha 1 Fpo Ap 96622-1600, San Diego, CA 92136 | 2007-01-02 |
| 1396814836 | Alberia Joseph Davis | Military Health Care Provider | Pcd Sampson (ddg-102), 3975 Norman Scott Rd, San Diego, CA 92136 | 2006-11-07 |
| 1831275866 | Roslyn Jones Jackson | Nurse Practitioner | 2450 Craven Streeet, San Diego, CA 92136 | 2006-10-31 |
| 1699743534 | Mark L Williamson | Military Health Care Provider | 3325 Senn Road, Comdesron One Building 55 Second Floor, San Diego, CA 92136 | 2006-03-08 |
| 1467423335 | John M. Hintz | Psychologist | Branch Medical Clinic, Naval Station, San Diego, CA 92136 | 2006-01-30 |
| 1659341089 | Kenichi Carrigan | Preventive Medicine | 3235 Albacore Alley, San Diego, CA 92136 | 2006-01-26 |
| Find all providers in zip 92136 | ||||
| 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.