Provider Demographics
NPI:1053598557
Name:COAST GUARD ISC NOLA
Entity type:Organization
Organization Name:COAST GUARD ISC NOLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGO-VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-329-1421
Mailing Address - Street 1:1790 SATURN ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129
Mailing Address - Country:US
Mailing Address - Phone:504-253-6506
Mailing Address - Fax:
Practice Address - Street 1:1790 SATURN ROAD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-2218
Practice Address - Country:US
Practice Address - Phone:504-253-6506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient