Healthcare Provider Details

I. General information

NPI: 1124176185
Provider Name (Legal Business Name): US COAST GUARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MACARTHUR CSWY
MIAMI FL
33139-5101
US

IV. Provider business mailing address

4005 SW 103RD AVE
MIAMI FL
33165-4947
US

V. Phone/Fax

Practice location:
  • Phone: 305-535-4535
  • Fax:
Mailing address:
  • Phone: 305-735-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NYREE NATASHA COOKE
Title or Position: CERTIFIED MEDICAL ASSISTANT
Credential: CMA
Phone: 305-535-4535