30TH Medgrp-Vandenberg

Primary specialty

Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X

Legal business name

30TH MEDGRP-VANDENBERG

Practice address

338 S Dakota Ave
Vandenberg Afb, CA 93437-6307

Phone

(805) 606-3012

Fax

(805) 606-4474

NPI assigned

Nov 28, 2005

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

Jen Lewandowski

Title

Defense Health Agency (Dha) Financi

Phone

(703) 817-4030

Specialties & licenses 3

Addresses

Other identifiers 1

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 Pharmacy
  • Vandenberg Afb, CA
  • NPI 1043626419
  NPD tax ID

Locations

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

{
    "created_epoch": "1133136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749686400000",
    "number": "1477536126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "338 S DAKOTA AVE",
            "city": "VANDENBERG AFB",
            "state": "CA",
            "postal_code": "934376307",
            "telephone_number": "805-606-3012",
            "fax_number": "805-606-4474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "338 S DAKOTA AVE",
            "city": "VANDENBERG AFB",
            "state": "CA",
            "postal_code": "934376307",
            "telephone_number": "805-606-3012",
            "fax_number": "805-606-4474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "30TH MEDGRP-VANDENBERG",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "30TH MEDGRP-VANDENBERG",
        "enumeration_date": "2005-11-28",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A",
        "authorized_official_last_name": "LEWANDOWSKI",
        "authorized_official_first_name": "JEN",
        "authorized_official_title_or_position": "DEFENSE HEALTH AGENCY (DHA) FINANCI",
        "authorized_official_telephone_number": "703-817-4030"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1101X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332000000X",
            "taxonomy_group": "",
            "desc": "Military/U.S. Coast Guard Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "05-49759",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• All providers in Vandenberg Afb, CA
• Military/U.S. Coast Guard Outpatient Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.