Provider Demographics
NPI:1184603714
Name:US COAST GUARD SECTOR SAN JUAN
Entity type:Organization
Organization Name:US COAST GUARD SECTOR SAN JUAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF, HEALTH SERVICES DIVISION
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-729-2305
Mailing Address - Street 1:5 CALLE LA PUNTILLA
Mailing Address - Street 2:U.S. COAST GUARD SECTOR SAN JUAN CLINIC COMMANDING OFFI
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-1818
Mailing Address - Country:US
Mailing Address - Phone:787-729-2305
Mailing Address - Fax:
Practice Address - Street 1:5 CALLE LA PUNTILLA
Practice Address - Street 2:U.S. COAST GUARD SECTOR SAN JUAN CLINIC COMMANDING OFFI
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-1818
Practice Address - Country:US
Practice Address - Phone:787-729-2305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10478261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center