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General NPI Number Information
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NPI Number | 1104153279
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Entity Type | Organization
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Legal Business Name | US COAST GUARD
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Dates
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Enumeration Date | 11/11/2009
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Last Update Date | 11/11/2009
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Provider Practice Location Address
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Address Line | USCGC MORGENTHAU
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City | FPO
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State | AP
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Zip | 96672-3916
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Country | US
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Telephone | 501-437-3981
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Fax |
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Provider Business Mailing Address
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Address Line | 91-1035 KAI LOLI STREET
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City | EWA BEACH
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State | HI
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Zip | 96706
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Country | US
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Telephone | 501-437-3981
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Fax |
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Authorized Official
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Title or Position | CDR
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Name | DR. NIDHI JAIN,
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Credential | M.D
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Telephone | 510-437-3688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2008333
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License Number State | CA
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