Paul Andrew Virtue Jr., SOIDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

License

02239573PV Issued in NC

Practice address

1St Recon BN Bas
Camp Pendleton, CA 92055

Phone

(760) 725-8912

NPI assigned

Oct 5, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1696464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1073393070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 555584",
            "city": "CAMP PENDLETON",
            "state": "CA",
            "postal_code": "920555584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1ST RECON BN BAS",
            "city": "CAMP PENDLETON",
            "state": "CA",
            "postal_code": "92055",
            "telephone_number": "760-725-8912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIRTUE",
        "first_name": "PAUL",
        "middle_name": "ANDREW",
        "name_suffix": "Jr.",
        "credential": "SOIDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-05",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": "NC",
            "license": "02239573PV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Juanita Vega
• Travis Jonathan Vertolli, DMD
• Alexander Joseph Vidunas
• Enrique Villanueva, SOIDC
• Bernadette Zarate Villareal
• Tammy T Vo, RDH
• John David Wagner, M.D.
• Justin Cody Waldron, DDS
• Debbie Elizabeth Walker, LDH, RDH, BSC
• Jordan R Walker, SOIDC

• Independent Duty Corpsman in Camp Pendleton, CA
• Providers in Camp Pendleton, CA by specialty
• Independent Duty Corpsman in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; 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.