Healthcare Provider Details

I. General information

NPI: 1760928923
Provider Name (Legal Business Name): USCG CLINIC AIR STATION MIAMI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14750 NW 44TH CT
OPA LOCKA FL
33054-2304
US

IV. Provider business mailing address

14750 NW 44TH CT
OPA LOCKA FL
33054-2304
US

V. Phone/Fax

Practice location:
  • Phone: 757-628-4363
  • Fax:
Mailing address:
  • Phone: 757-628-4363
  • 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: DEBRA FITZGERALD
Title or Position: HSWL SC
Credential:
Phone: 757-628-4363