| Organization Name: | BRANCH MEDICAL CLINIC CHINA LAKE |
| NPI Number: | 1023212677 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSE MANUEL BUSTO (FINANCIAL TECHNICIAN) |
| Mailing Address: | 1 Administration Cir Ridgecrest |
| State: | CA US |
| Postal Code: | 935556104 |
| Phone Number: | 7608302498 |
| Fax Number: | 7608302182 |
| NPI Enumeration Date: | 06/14/2007 |
| NPI Last Update Date: | 08/28/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Military/U.S. Coast Guard Outpatient |
| Taxonomy Definition: | The Defense Health Program or U.S. Coast Guard funded |