Provider Demographics
NPI:1942384383
Name:COMDT (CG-1122)
Entity Type:Organization
Organization Name:COMDT (CG-1122)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:LORELEI
Authorized Official - Last Name:DIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-765-7200
Mailing Address - Street 1:U S COAST GUARD 2100 2ND ST SW STE 5314
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:707-765-7200
Mailing Address - Fax:707-765-7521
Practice Address - Street 1:U S COAST GUARD 2100 2ND ST SW STE 5314
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:707-765-7200
Practice Address - Fax:707-765-7521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty