DR. KRISTEN AZZAM (NPI# 1801389465) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801389465 |
| Entity Type | Individual |
| Full Name | DR. KRISTEN AZZAM |
| Credential | MD |
| Practice Address |
200 Mercy Circle Camp Pendleton CA 92055 |
| Mailing Address |
Po Box 555191 Camp Pendleton CA 92055-5191 |
| Practice Telephone | 7206350445 |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2019-07-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171000000X | Military Health Care Provider | Other Service Providers |
| Street Address |
200 MERCY CIRCLE |
| City | CAMP PENDLETON |
| State | CA |
| Zip Code | 92055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649255415 | Wayne Thomas Murphy | Preventive Medicine | 200 Mercy Circle, Camp Pendleton, CA 92055-5191 | 2005-12-14 |
| 1679172621 | James Darko Ofori | Military Health Care Provider | 200 Mercy Circle, Pharmacy Department, Camp Pendleton, CA 92055 | 2020-10-21 |
| 1194354662 | Melissa Bruebaker | Military Health Care Provider | 200 Mercy Circle, Camp Pendleton, CA 92055-5191 | 2020-04-06 |
| 1891322269 | Pierce Derico | Student in an Organized Health Care Education/Training Program | 200 Mercy Circle, Camp Pendleton, CA 92055-5191 | 2020-03-25 |
| 1871120774 | Rebeca Arias | Student in an Organized Health Care Education/Training Program | 200 Mercy Circle, Camp Pendleton, CA 92055 | 2020-03-23 |
| 1871128710 | Angela Christine Lacey | Student in an Organized Health Care Education/Training Program | 200 Mercy Circle, Camp Pendleton, CA 92055-5191 | 2020-03-11 |
| 1447800727 | David Singleton | Dentist | 200 Mercy Circle, Camp Pendleton, CA 92055-6527 | 2019-09-18 |
| 1689233470 | Bryce Allen Bowers | Student in an Organized Health Care Education/Training Program | 200 Mercy Circle, Camp Pendleton, CA 92055 | 2019-06-06 |
| 1629636477 | Nikolas Brien Gutierrez | General Practice | 200 Mercy Circle, Camp Pendleton, CA 92055 | 2019-06-05 |
| 1518525369 | Elizabeth Helen Shields | Student in an Organized Health Care Education/Training Program | 200 Mercy Circle, Camp Pendleton, CA 92055-5191 | 2019-06-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235730755 | Zaccary Griffin | Military Health Care Provider | Building 4101 Stuart Mesa Rd, Camp Pendleton, CA 92055 | 2020-11-02 |
| 1194325597 | Connie Lim Good | Dental Hygienist | 14th Street Bldg 13128, Oceanside, CA 92055 | 2020-10-27 |
| 1386243327 | Leticia Isabel Alcantar | Dental Hygienist | Bldg 520448, Camp Pendleton, CA 92055 | 2020-10-21 |
| 1548869571 | Joshua Watersjackson | Specialist/Technologist | 430406 Las Pulgas, Camp Pendleton, CA 92055 | 2020-10-21 |
| 1235737164 | Tynesha Felice Calimquim | Dental Hygienist | Naval Hospital Camp Pendleton, Dental Department, 200 Mercy Circle, Oceanside, CA 92055 | 2020-10-13 |
| 1801494182 | Luis Alberto Necoechea | Military Health Care Provider | 1st Recon Bn Bas, Oceanside, CA 92055 | 2020-10-09 |
| 1689271603 | Lorena Santodomingo | Dental Hygienist | Bldg 210735 C Street, Camp Pendleton, CA 92055 | 2020-10-02 |
| 1720695984 | Douglas Thomas Duncan | Dental Assistant | 92055- 14th Strret, Oceanside, CA 92055 | 2020-09-30 |
| 1528675980 | Dora Louise Young | Dental Assistant | 92055 14th Street, Camp Pendleton, CA 92055 | 2020-09-29 |
| 1306453956 | Lynne Marie Reardon | Dental Hygienist | Bldg 310515, Camp Pendleton, CA 92055 | 2020-09-28 |
| Find all providers in zip 92055 | ||||
| Taxonomy Code | 171000000X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |
| Notes: [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235730755 | Zaccary Griffin | Military Health Care Provider | Building 4101 Stuart Mesa Rd, Camp Pendleton, CA 92055 | 2020-11-02 |
| 1578124194 | David M Allen | Military Health Care Provider | 1st Mlg, Bldg 150121, Camp Pendleton, CA 92055 | 2019-06-25 |
| 1356846984 | Jessica Nieto | Military Health Care Provider | 1st Battalion, 4th Marines, Camp Pendleton, CA 92055 | 2018-03-26 |
| 1275910556 | Vincent Hurtado | Military Health Care Provider | 1st Lar Bas, Box 5555642, Camp Pendleton, CA 92054 | 2015-05-06 |
| 1851731921 | Michael S Busby | Military Health Care Provider | H100 Santa Margarita Road Attn: Code 00qm, Naval Hospital, Camp Pendleton, Camp Pendleton, CA 92055-5191 | 2013-07-03 |
| 1245596832 | Garrett Blaze Dearing | Military Health Care Provider | Bldg 4130077 East Marsoc, 1st Marine Special Operations Batallion, Camp Pendleton, CA 92055-5020 | 2012-04-09 |
| 1285931279 | Julie Ann Wheeler | Military Health Care Provider | 22190 Avenue E, 1st Medical Battalion, Clr-15, 1st Mlg, Marforpac, Camp Pendleton, CA 92055-5657 | 2011-02-28 |
| 1679172621 | James Darko Ofori | Military Health Care Provider | 200 Mercy Circle, Pharmacy Department, Camp Pendleton, CA 92055 | 2020-10-21 |
| 1427672583 | Megan Patrice Twite | Military Health Care Provider | Naval Hospital Camp Pendleton, 200 Mercy Circle, Camp Pendleton, CA 92055 | 2020-06-04 |
| 1194354662 | Melissa Bruebaker | Military Health Care Provider | 200 Mercy Circle, Camp Pendleton, CA 92055-5191 | 2020-04-06 |
| Find all providers in CAMP PENDLETON | ||||
| City | CAMP PENDLETON |
| Zip Code | 92055 |
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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.