| NPI | 1043668775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY SANTIAGO Np 256-508-9034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient (Licence: MD R 187467) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2016-06-03 |