Provider Demographics
NPI:1366856437
Name:NMC SAN DIEGO
Entity type:Organization
Organization Name:NMC SAN DIEGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF DHA POSC
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:CO CAPTAIN OLAF HAUGEN
Mailing Address - Street 2:34520 BOB WILSON DR STE 20
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-0001
Mailing Address - Country:US
Mailing Address - Phone:619-532-8400
Mailing Address - Fax:619-532-5898
Practice Address - Street 1:34800 BOB WILSON DR STE 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-5000
Practice Address - Country:US
Practice Address - Phone:619-532-8400
Practice Address - Fax:760-763-1024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NMC SAN DIEGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-17
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146228OtherPK