Provider Demographics
NPI:1942353693
Name:U.S COAST GUARD
Entity Type:Organization
Organization Name:U.S COAST GUARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-732-7519
Mailing Address - Street 1:2100 2ND ST SW
Mailing Address - Street 2:SUITE 5314
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 2ND ST SW
Practice Address - Street 2:SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0002
Practice Address - Country:US
Practice Address - Phone:202-267-0801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure