61ST MEDICAL SQUADRON (NPI# 1538145412) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538145412 |
| Entity Type | Organization |
| Organization Name | 61ST MEDICAL SQUADRON |
| Practice Address |
2420 Vela Way Suite 1866 El Segundo CA 90245-4659 |
| Mailing Address |
2420 Vela Way Ste 1467 El Segundo CA 90245-4659 |
| Practice Telephone | 3103636640 |
| Practice Fax Number | 3103630243 |
| Mailing Telephone | 3106536437 |
| Mailing Fax Number | 3106530243 |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2014-05-21 |
| Authorized Official Name | MS. THERESA M. MITCHELL (AF UBO ANALYST) |
| Authorized Official Telephone | 7036817613 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers | ||
| N | 261QM1101X |
Clinic/Center Specialization: Military and U.S. Coast Guard Ambulatory Procedure |
Ambulatory Health Care Facilities | ||
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | NCPDP | 05-37918 | 01 |
| Street Address |
2420 VELA WAY SUITE 1866 |
| City | EL SEGUNDO |
| State | CA |
| Zip Code | 90245-4659 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215922158 | Maria Lynn Pugia | Physical Therapist | 2420 Vela Way, Suite 1467, El Segundo, CA 90245-4659 | 2005-09-16 |
| 1881683035 | Brian Keith Deckert | Optometrist | 2420 Vela Way, Suite 1866, El Segundo, CA 90245-4659 | 2005-10-20 |
| 1023003670 | Viki T Lin | Family Medicine | 2420 Vela Way, Suite 1467, El Segundo, CA 90245 | 2005-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366058976 | Britt'nee Cornelius | Massage Therapist | 222 North PCh, Suite 2000, El Segundo, CA 90245 | 2020-09-18 |
| 1750913778 | Laurie Ann Scoppetto | Dietitian, Registered | 482 N Aviation Blvd, El Segundo, CA 90245 | 2020-02-07 |
| 1972135283 | A Dabrowska Dds, Inc | Dentist | 390 N. Pacific Coast Hwy #1050, El Segundo, CA 90245 | 2020-02-05 |
| 1578023057 | Miles Bertumen | Pharmacist | 283 N Aviation Blvd, Building 210, El Segundo, CA 90245 | 2019-03-21 |
| 1831673201 | Kriss L. Killam | Marriage & Family Therapist | 302 W. Grand Ave., Suite 9, El Segundo, CA 90245 | 2018-09-20 |
| 1811487911 | Bright Light Recovery | Substance Abuse Rehabilitation Facility | 218 Concord St, Suite C, El Segundo, CA 90245 | 2018-05-14 |
| 1265950448 | Sarah Yuriko Mizuki | Physician Assistant | 390 N PCh, Suite 1000, El Segundo, CA 90245 | 2017-09-07 |
| 1326586462 | Jlp Interpreting Services | Interpreter | 963 Virginia St #5, El Segundo, CA 90245 | 2017-02-09 |
| 1619351707 | El Segundo Dermatology, Inc. | Specialist | 713 N Douglas St., El Segundo, CA 90245 | 2015-07-17 |
| 1083956635 | 24hr Homecare, LLC | Home Health | 200 N. Pacific Coast Highway, Suite 300, El Segundo, CA 90245 | 2013-03-21 |
| Find all providers in zip 90245 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538727276 | Uscg Clinic San Francisco | Clinic/Center | 1020 N Access Rd, San Francisco, CA 94128-3120 | 2019-05-29 |
| 1154715803 | Branch Medical Clinic Area 33 | Clinic/Center | 33 Area Branch Medical Clinic, Bldg 330305, Camp Pendleton, CA 92055 | 2015-03-20 |
| 1790179455 | Naval Hospital Camp Pendleton | Clinic/Center | 41 Area Branch Medical Clinic, Bldg 414006, Camp Pendleton, CA 92055 | 2015-03-20 |
| 1245624907 | Branch Medical Clinic Area 43 | Clinic/Center | 43 Area Branch Medical Clinic, Bldg 434057, Camp Pendleton, CA 92055 | 2015-03-20 |
| 1154715811 | Branch Medical Clinic Area 53 | Clinic/Center | 53 Area Branch Medical Clinic, Bldg 533020, Camp Pendleton, CA 92055 | 2015-03-20 |
| 1801288634 | Branch Medical Clinic Nalf San Clemente Island | Clinic/Center | Wilson Cove, Bldg 60126, San Clemente, CA 92135 | 2015-03-03 |
| 1023400256 | Branch Medical Clinic Mcas Miramar | Clinic/Center | Bauer Rd, Bldg 2496, San Diego, CA 92145-0001 | 2015-02-25 |
| 1083028989 | Weed Army Community Hospital | Clinic/Center | Bldg 189 Ave B, Fort Irwin, CA 92310 | 2014-06-18 |
| 1891109799 | Weed Army Community Hospital | Clinic/Center | Ave B Bldg R190, Warrior Care Center, Fort Irwin, CA 92310 | 2014-06-18 |
| 1871832394 | Branch Medical Clinic Area 62 | Clinic/Center | Bldg 620306 8th Street, Camp Pendleton, CA 92055 | 2013-02-04 |
| Find all providers with the same taxonomy | ||||
| City | EL SEGUNDO |
| Zip Code | 90245 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.