# U.S. NAVY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538120068
- **Authorized official:** BENEDICTO VICENCIO MANALANSAN (INDEPENDENT DUTY CORPSMAN)
- **Authorized official phone:** (619) 475-1100

## Contact information

- **Practice address:** 34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
- **Practice address phone:** (619) 245-1693
- **Mailing address:** 2240 SPRING OAK WAY, SAN DIEGO, CA 92139-3922
- **Mailing address phone:** (619) 475-1100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1710I1002X | Independent Duty Corpsman | — | NULL | Yes |
| 1710I1002X | Independent Duty Corpsman | — | — | Yes |

## Other

- **Enumeration date:** 04/02/2006
- **Last updated:** 05/19/2008