Organization
UNITED STATES COAST GUARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON CONRAD FERNANDEZ JR. (HS3)
(619) 992-5671
Entity
Organization
Contact information
Practice address
427 COMMERCIAL ST, CLINIC, BOSTON, MA 02109-1027
(619) 992-5671
Mailing address
427 COMMERCIAL ST, CLINIC, BOSTON, MA 02109-1027
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
D4080169
CA
Other
Enumeration date
07/26/2007
Last updated
07/26/2007
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