30TH Medgrp-Vandenberg

Primary specialty

Military/U.S. Coast Guard PharmacyTaxonomy code 332000000X

Legal business name

30TH MEDGRP-VANDENBERG

Doing business as

DoD VANDENBERG ePhcy

Practice address

338 S Dakota Ave BLDG 13850
Vandenberg AFB, CA 93437-6307

Phone

(805) 606-7440

Fax

(805) 605-8380

NPI assigned

Jul 7, 2014

Last updated

Jun 13, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

30TH MEDGRP-VANDENBERGAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Hector Morales

Title

Chief Dha Pass

Phone

(210) 536-6650

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DoD VANDENBERG ePhcy Doing business as

Tax ID family

30TH Medgrp-Vandenberg2 organizations share this tax ID, including this one

Part of

30TH Medgrp-Vandenberg

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 30TH Medgrp-Vandenberg

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Vandenberg AFB, CA
  • NPI 1477536126
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749772800000",
    "number": "1043626419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30TH MEDICAL GROUP",
            "address_2": "338 S. DAKOTA ST. STE 131-56",
            "city": "VANDENBERG AFB",
            "state": "CA",
            "postal_code": "934376307",
            "telephone_number": "805-606-7440",
            "fax_number": "805-605-8380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "338 S DAKOTA AVE BLDG 13850",
            "city": "VANDENBERG AFB",
            "state": "CA",
            "postal_code": "934376307",
            "telephone_number": "805-606-7440",
            "fax_number": "805-605-8380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "30TH MEDGRP-VANDENBERG",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "30TH MEDGRP-VANDENBERG",
        "enumeration_date": "2014-07-07",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "status": "A",
        "authorized_official_last_name": "MORALES",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_title_or_position": "CHIEF DHA PASS",
        "authorized_official_telephone_number": "210-536-6650"
    },
    "taxonomies": [
        {
            "code": "332000000X",
            "taxonomy_group": "",
            "desc": "Military/U.S. Coast Guard Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2146678",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DoD VANDENBERG ePhcy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 30TH Medgrp-Vandenberg
• Sandra Lopez Avalos, MSW
• Benjamin Graham Bacon, DDS
• David Ivan Bermejo, DO
• Aaron J Bilow, RPH

• Military/U.S. Coast Guard Pharmacy in Vandenberg AFB, CA
• Providers in Vandenberg AFB, CA by specialty
• Military/U.S. Coast Guard Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.