Provider Demographics
NPI:1124176185
Name:US COAST GUARD
Entity type:Organization
Organization Name:US COAST GUARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:NYREE
Authorized Official - Middle Name:NATASHA
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:305-535-4535
Mailing Address - Street 1:4005 SW 103RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4947
Mailing Address - Country:US
Mailing Address - Phone:305-735-2276
Mailing Address - Fax:
Practice Address - Street 1:100 MACARTHUR CSWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33139-5101
Practice Address - Country:US
Practice Address - Phone:305-535-4535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service