Provider Demographics
NPI:1487860656
Name:COAST GUARD HEADQUARTERS
Entity Type:Organization
Organization Name:COAST GUARD HEADQUARTERS
Other - Org Name:ISC ALAMEDA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTER NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:SAN LUIS
Authorized Official - Last Name:TABERBERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-437-3582
Mailing Address - Street 1:2100 2ND STREET
Mailing Address - Street 2:SUITE 5314
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593
Mailing Address - Country:US
Mailing Address - Phone:510-437-3582
Mailing Address - Fax:
Practice Address - Street 1:1 EAGLE RD
Practice Address - Street 2:BLDG #1
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5100
Practice Address - Country:US
Practice Address - Phone:510-437-3582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA344918261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service