Healthcare Provider Details

I. General information

NPI: 1326100827
Provider Name (Legal Business Name): USCG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EAGLE RD
ALAMEDA CA
94501-5100
US

IV. Provider business mailing address

1 EAGLE RD
ALAMEDA CA
94501-5100
US

V. Phone/Fax

Practice location:
  • Phone: 510-407-7797
  • Fax:
Mailing address:
  • Phone: 510-437-3582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BROOKE ASHLEY YOUNG
Title or Position: HEALTH SERVICE TECH
Credential: LAB TECH
Phone: 510-437-3582