Healthcare Provider Details

I. General information

NPI: 1538393327
Provider Name (Legal Business Name): UNITED STATES COAST GUARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ISC ALAMEDA COAST GUARD ISLAND, BLDG 1
ALAMEDA CA
94501
US

IV. Provider business mailing address

COAST GUARD ISLAND ISC ALAMEDA CLINIC BLDG. 1
ALAMEDA CA
94501
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-3582
  • 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: MISS TINA OWEN
Title or Position: LT
Credential:
Phone: 510-437-3582