# MEDDAC-WACH

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

## Provider details

- **NPI number:** 1720018757
- **Authorized official:** MARITSA IRBY (LPN)
- **Authorized official phone:** (760) 380-7343

## Contact information

- **Practice address:** 5092 SUPERIOR VALLEY CT \# B, FORT IRWIN, CA 92310-2046
- **Practice address phone:** (760) 386-8320
- **Mailing address:** 5092 SUPERIOR VALLEY CT \# B, FORT IRWIN, CA 92310-2046
- **Mailing address phone:** (760) 386-8320

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 286500000X | Military Hospital | PN5167255 | FL | Yes |

## Other

- **Enumeration date:** 07/04/2006
- **Last updated:** 08/22/2020