Healthcare Provider Details

I. General information

NPI: 1750430864
Provider Name (Legal Business Name): US COAST GUARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MACARTHUR CSWY
MIAMI BEACH FL
33139-5101
US

IV. Provider business mailing address

100 MACARTHUR CSWY
MIAMI BEACH FL
33139-5101
US

V. Phone/Fax

Practice location:
  • Phone: 305-535-4350
  • Fax:
Mailing address:
  • Phone: 305-535-4350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberQ535-740-86-208-0
License Number StateFL

VIII. Authorized Official

Name: MR. RICHARD QUINTANA
Title or Position: HEALTH SERVICES TECHNICIAN
Credential:
Phone: 305-535-4350