Healthcare Provider Details

I. General information

NPI: 1538359922
Provider Name (Legal Business Name): USNH YOKOSUKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 475 BOX 1 CODE 08
FPO AP
96350
JP

IV. Provider business mailing address

PSC 475 BOX 1 CODE 08
FPO AP
96350
JP

V. Phone/Fax

Practice location:
  • Phone: 01181468168574
  • Fax:
Mailing address:
  • Phone: 01181468168574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GWENDOLYN DISHON STARKS
Title or Position: CLAIMS ASSISTANT
Credential:
Phone: 01181468068574