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Organization
30TH MEDGRP-VANDENBERG
Active
Organization
30TH MEDGRP-VANDENBERG
Active
Parent organization
30TH MEDGRP-VANDENBERG
Organization subpart
Yes
Provider details
NPI number
Legal business name
30TH MEDGRP-VANDENBERG
Authorized official
JEN LEWANDOWSKI (DEFENSE HEALTH AGENCY (DHA) FINANCI)
(703) 817-4030
Entity
Organization
Contact information
Practice address
338 S DAKOTA AVE, VANDENBERG AFB, CA 93437-6307
(805) 606-3012
(805) 606-4474
Mailing address
338 S DAKOTA AVE, VANDENBERG AFB, CA 93437-6307
(805) 606-3012
(805) 606-4474
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
NULL
261QM1101X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
—
NULL
332000000X
Military/U.S. Coast Guard Pharmacy
—
NULL
Other
Enumeration date
11/28/2005
Last updated
06/12/2025
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