Organization
BRANCH MEDICAL CLINIC EL CENTRO
Active
Parent organization
NAVAL MEDICAL CENTER SAN DIEGO
Organization subpart
Yes
Provider details
NPI number
Legal business name
NAVAL MEDICAL CENTER SAN DIEGO
Authorized official
MR. WILLIAM MICHAEL CONDON (NAVY MEDICINE UBO PROGRAM MANAGER)
(240) 401-3643
Entity
Organization
Contact information
Practice address
NAVAL BRANCH HEALTH CLINIC, NAVAL AIR FACILITY BLDG 523, EL CENTRO, CA 92243
(760) 339-2674
(760) 339-2661
Mailing address
34520 BOB WILSON DR, SAN DIEGO, CA 92134-2098
(619) 532-6636
(619) 532-6645
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-20862
NCPDP
CA
01
—
05022F
MEDICARE
CA
05
—
HSP63228F
—
CA
05
—
ZZT23228F
—
CA
Enumeration date
08/14/2007
Last updated
03/07/2023
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