# AIR FORCE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** David Grant Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013079334
- **Authorized official:** MARCOS J LOPEZ (CLINICAL PHARMACIST)
- **Authorized official phone:** (707) 423-3459

## Contact information

- **Practice address:** 2569 SHOREY WAY, FAIRFIELD, CA 94533-6562
- **Practice address phone:** (707) 816-8622
- **Mailing address:** 2569 SHOREY WAY, FAIRFIELD, CA 94533-6562

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 286500000X | Military Hospital | 4679 | PR | Yes |

## Other

- **Enumeration date:** 12/14/2006
- **Last updated:** 08/22/2020