NPIMap

Organization Active NPI

Tricare Outpatient Clinic Chula Vista

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Chula Vista, CA
National Provider Identifier
1467644625
Registry record updated Apr 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X
Legal business name
TRICARE OUTPATIENT CLINIC CHULA VISTA
Practice address
644 Naples St
Chula Vista, CA 91911-1636
Phone
(619) 744-5354
Fax
(619) 744-5391
NPI assigned
Aug 13, 2007
Organization subpart
Yes
Parent organization
NAVAL MEDICAL CENTER SAN DIEGOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 4, 2019

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

Authorized official

Name
Mr. William Michael Condon
Title
Navy Medicine Ubo Program Manager
Phone
(240) 401-3643

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Military/U.S. Coast Guard Outpatient Clinic/Center 261QM1100X Primary

Addresses

Primary practice location

644 Naples St
Chula Vista, CA 91911-1636

Mailing address

34520 Bob Wilson Dr
San Diego, CA 92134-2098
Phone (619) 532-6636

National Provider Directory

National Provider Directory
Tax ID family
Naval Medical Center San Diego26 organizations share this tax ID, including this one
Part of
Naval Medical Center San Diego

Other organizations with this tax ID 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554336000000",
    "number": "1467644625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34520 BOB WILSON DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921342098",
            "telephone_number": "619-532-6636",
            "fax_number": "619-532-6645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 NAPLES ST",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919111636",
            "telephone_number": "619-744-5354",
            "fax_number": "619-744-5391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRICARE OUTPATIENT CLINIC CHULA VISTA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NAVAL MEDICAL CENTER SAN DIEGO",
        "enumeration_date": "2007-08-13",
        "last_updated": "2019-04-04",
        "status": "A",
        "authorized_official_last_name": "CONDON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "NAVY MEDICINE UBO PROGRAM MANAGER",
        "authorized_official_telephone_number": "240-401-3643",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2019; 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.