Provider Demographics
NPI:1366527764
Name:NAVAL MEDICAL CENTER SAN DIEGO
Entity type:Organization
Organization Name:NAVAL MEDICAL CENTER SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT HEAD
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:VALENTINE
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-532-7150
Mailing Address - Street 1:4412 UPLAND ST
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-6517
Mailing Address - Country:US
Mailing Address - Phone:610-469-7335
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-532-7355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 17684282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital