Organization
U.S COAST GUARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID ROMERO (CLINIC ADMINISTRATOR)
(310) 732-7519
Entity
Organization
Contact information
Practice address
2100 2ND ST SW, SUITE 5314, WASHINGTON, DC 20593-0002
(202) 267-0801
Mailing address
2100 2ND ST SW, SUITE 5314, WASHINGTON, DC 20593-0002
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24720000X
24720000X
DC
Enumeration date
01/18/2007
Last updated
08/22/2020
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