NAVAL MEDICAL CENTER SAN DIEGO (NPI# 1639278682) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639278682 |
| Entity Type | Organization |
| Organization Name | NAVAL MEDICAL CENTER SAN DIEGO |
| Other Organization Name | SAN DG NAB CORONADO PHCY |
| Practice Address |
Bouganville Rd Bldg 506 San Diego CA 92155-0001 |
| Practice Telephone | 6194372497 |
| Practice Fax Number | 6195325898 |
| Mailing Telephone | 6194372497 |
| Mailing Fax Number | 6195325898 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2016-01-15 |
| Authorized Official Name | HECTOR MORALES (CHIEF DHA PASS) |
| Authorized Official Telephone | 2105366650 |
| Is Organization Subpart | N |
| 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 | 2028523 | 01 |
| Other Name | Type Code |
|---|---|
| SAN DG NAB CORONADO 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 |
| 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 |
| Street Address |
BOUGANVILLE RD BLDG 506 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92155-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134454770 | Carrie Lynn Decker | Military Health Care Provider | Eod Exp Support Unit One, 3502 Attu Rd Bldg 326 San Diego Ca, Apo, AA 92155 | 2009-10-15 |
| 1578779559 | Joe Leonard Bonvie | Psychologist | Naval Special Warfare Command, Medical Dept Code 04, 2000 Trident Way, San Diego, CA 92155 | 2007-05-15 |
| 1134350226 | Christopher Robert Terry | Military Health Care Provider | 2446 Trident Way, Coranado, CA 92155 | 2009-08-06 |
| 1003840653 | Robert David Gerardi | Military Health Care Provider | 2841 Rendova Road, San Diego, CA 92155 | 2006-07-10 |
| 1346597234 | Jermy Joe Brower | Military Health Care Provider | Seal Team One 2534 Trident Way Bldg 614, San Diego, CA 92155-0001 | 2012-08-09 |
| 1720376684 | Brittany A Hout | Physician Assistant | Anaconda Rd Bldg 262, San Diego, CA 92155-0001 | 2011-07-13 |
| 1902393176 | Benjamin Alexander Sebreros | Student in an Organized Health Care Education/Training Program | 2446 Trident Way Bldg 637, San Diego, CA 92155-0001 | 2018-04-13 |
| 1790056372 | U. S. Navy | Military Hospital | 3423 Guadalcanal Rd, Bldg 401 2nd Deck, San Diego, CA 92155-5000 | 2012-01-13 |
| 1366592248 | Robert Ray Lowe Jr. | Emergency Medicine | 3400 Tarawa Rd, San Diego, CA 92155-5002 | 2007-01-11 |
| 1801868633 | Michael Griffin Swanson | Family Medicine | Naval Special Warfare Group Three, 3400 Tarawa Road Bldg.19, San Diego, CA 92155-5002 | 2006-02-06 |
| Find all providers in zip 92155 | ||||
| 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 |
| 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 |
| 1063766459 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | 11770 Bernardo Plaza Ct, Suite 250, San Diego, CA 92128-2422 | 2012-11-07 |
| 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.