Provider Demographics
NPI:1316113665
Name:NAVAL HOSPITAL CAMP PENDLETON
Entity type:Organization
Organization Name:NAVAL HOSPITAL CAMP PENDLETON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL LABORATORY TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOVELLANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-725-1495
Mailing Address - Street 1:BLDG H100 SANTA MARGARITA ROAD
Mailing Address - Street 2:
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92058-0000
Mailing Address - Country:US
Mailing Address - Phone:760-725-1495
Mailing Address - Fax:
Practice Address - Street 1:H100 SANTA MARGARITA ROAD
Practice Address - Street 2:
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92058
Practice Address - Country:US
Practice Address - Phone:760-725-1495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital