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General NPI Number Information
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NPI Number | 1881952661
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Entity Type | Organization
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Legal Business Name | UNDERWATER CONSTRUCTION TEAM TWO
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 4643 DOCK ROAD BLDG 524 UNDERWATER CONSTRUCTION TEAM TWO
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City | PORT HUENEME
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State | CA
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Zip | 93043
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Country | US
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Telephone | 805-982-6682
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Fax | 805-982-3246
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Provider Business Mailing Address
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Address Line | 4643 DOCK ROAD BLDG 524 UNDERWATER CONSTRUCTION TEAM TWO
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City | PORT HUENEME
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State | CA
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Zip | 93043
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Country | US
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Telephone | 805-982-6682
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Fax | 805-982-3246
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Authorized Official
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Title or Position | HOSPITAL CORPSMAN IDC
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Name | MR. TIMOTHY J KERR
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Credential | DIVE IDC
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Telephone | 805-982-6682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3418M1110X
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Taxonomy Name | Military or U.S. Coast Guard Ground Transport Ambulance
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License Number |
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License Number State |
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