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General NPI Number Information
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NPI Number | 1053076463
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Entity Type | Organization
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Legal Business Name | USCG SECTOR ST PETERSBURG CLINIC
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 600 8TH AVE SE
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City | ST PETERSBURG
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State | FL
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Zip | 33701-5030
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Country | US
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Telephone | 727-502-1586
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Fax | 727-502-7593
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Provider Business Mailing Address
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Address Line | 600 8TH AVE SE
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City | ST PETERSBURG
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State | FL
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Zip | 33701-5030
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Country | US
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Telephone | 727-502-1586
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Fax | 727-502-7593
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Authorized Official
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Title or Position | CHIEF DHA PASS
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Name | HECTOR MORALES
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Credential |
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Telephone | 210-536-6650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number |
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License Number State |
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