| Doctor Name: | DENNIS BUENAVENTURA CUSTODIO |
| NPI Number: | 1013264423 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | INDEPENDENT DUTY HM |
| License Number: | |
| Business Practice Address: | 69 Trout Ave Naval Undersea Medical Institute Groton, CT - 06349 |
| Business Phone Number: | 2539058239 |
| Business Fax Number: | |
| Mailing Address: | 6910 227th Street Ct E, SPANAWAY |
| State: | WA |
| Postal Code: | 983875841 |
| Phone Number: | 2539058239 |
| Fax Number: | |
| NPI Enumeration Date: | 08/06/2012 |
| NPI Last Update Date: | 08/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1710I1002X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | Independent Duty Corpsman |
| Taxonomy Definition: | A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |