Individual provider Active NPI

Robert Jess Valtierra III, IDC

  • Independent Duty Corpsman
  • San Diego, CA
National Provider Identifier
1760814073
Registry record updated Aug 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Independent Duty CorpsmanTaxonomy code 1710I1002X
Practice address
Surface Warfare Medical Institute
34101 Farenholt Avenue, Building 14
San Diego, CA 92134-0001
Phone
(619) 532-6195
NPI assigned
Aug 9, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Independent Duty Corpsman 1710I1002X Primary

Addresses

Primary practice location

Surface Warfare Medical Institute
34101 Farenholt Avenue, Building 14
San Diego, CA 92134-0001

Mailing address

5310 Repecho Dr
Apt V 104
San Diego, CA 92124-1726
Phone (808) 224-4721

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1376006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376006400000",
    "number": "1760814073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5310 REPECHO DR",
            "address_2": "APT V 104",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921241726",
            "telephone_number": "808-224-4721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SURFACE WARFARE MEDICAL INSTITUTE",
            "address_2": "34101 FARENHOLT AVENUE, BUILDING 14",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921340001",
            "telephone_number": "619-532-6195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALTIERRA",
        "first_name": "ROBERT",
        "middle_name": "JESS",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-09",
        "last_updated": "2013-08-09",
        "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": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2013; 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.