Provider Demographics
NPI:1851473292
Name:USCG INTEGRATED SUPPORT COMMAND ALAMEDA
Entity Type:Organization
Organization Name:USCG INTEGRATED SUPPORT COMMAND ALAMEDA
Other - Org Name:USCG ISC ALAMEDA HEALTH SERVICES CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF HEALTH SERVICES DIVISION
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERNO
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:510-437-3603
Mailing Address - Street 1:USCG INTERGRATED SUPPORT COMMAND HEALTH SERVICES CLINIC
Mailing Address - Street 2:COAST GUARD ISLAND
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5100
Mailing Address - Country:US
Mailing Address - Phone:510-437-3582
Mailing Address - Fax:510-437-3611
Practice Address - Street 1:USCG INTERGRATED SUPPORT COMMAND HEALTH SERVICES CLINIC
Practice Address - Street 2:COAST GUARD ISLAND
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:510-437-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient