Uscg Isc San Pedro Clinic

Primary specialty

Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X

Legal business name

USCG ISC SAN PEDRO CLINIC

Practice address

2100 2ND St SW
Suite 5314
Washington, DC 20593-0002

Phone

(202) 267-0801

NPI assigned

Jan 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Romero

Title

Clinic Administrator

Phone

(310) 732-7500

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003968942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 2ND ST SW",
            "address_2": "SUITE 5314",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "205930002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 2ND ST SW",
            "address_2": "SUITE 5314",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "205930002",
            "telephone_number": "202-267-0801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "USCG ISC SAN PEDRO CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROMERO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "310-732-7500"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": "DC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "24720000X",
            "identifier": "24720000X",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Military/U.S. Coast Guard Outpatient Clinic/Center in Washington, DC
• Providers in Washington, DC by specialty
• Military/U.S. Coast Guard Outpatient Clinic/Center in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.