Omar Gerardo Azmitia, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

34101 Farenholt Ave
Surface Warfare Medicine Institute
San Diegot, CA 92134

Phone

(619) 532-9476

NPI assigned

Jul 29, 2008

Last updated

Jul 29, 2008By the provider in NPPES

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

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

{
    "created_epoch": "1217289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217289600000",
    "number": "1669638722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34101 FARENHOLT AVE",
            "address_2": "SURFACE WARFARE MEDICINE INSTITUTE",
            "city": "SAN DIEGOT",
            "state": "CA",
            "postal_code": "92134",
            "telephone_number": "619-532-9476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34101 FARENHOLT AVE",
            "address_2": "SURFACE WARFARE MEDICINE INSTITUTE",
            "city": "SAN DIEGOT",
            "state": "CA",
            "postal_code": "92134",
            "telephone_number": "619-532-9476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZMITIA",
        "first_name": "OMAR",
        "middle_name": "GERARDO",
        "name_prefix": "Mr.",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-29",
        "last_updated": "2008-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2008; 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.