Provider Demographics
NPI:1154569572
Name:UNITED STATES NAVY
Entity type:Organization
Organization Name:UNITED STATES NAVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURFACE FORCE INDEPENDENT DUTY CORP
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VECERE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:559-707-0406
Mailing Address - Street 1:7032 STAR DUNE AVE
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277
Mailing Address - Country:US
Mailing Address - Phone:559-707-0406
Mailing Address - Fax:
Practice Address - Street 1:7032 STAR DUNE AVE
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-3090
Practice Address - Country:US
Practice Address - Phone:559-707-0406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8425286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital