| Organization Name: | USA MEDDAC, RWBAHC |
| NPI Number: | 1356700801 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CRYSTAL QUINTANA (LICENSED PRACTICAL NURSE) |
| Mailing Address: | 2240 Winrow Ave Fort Huachuca |
| State: | AZ US |
| Postal Code: | 85613 |
| Phone Number: | 5205339034 |
| Fax Number: | |
| NPI Enumeration Date: | 02/12/2016 |
| NPI Last Update Date: | 02/12/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | PN5193793 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |