Ethan Conall Cole, IDC

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1871211748

Ethan Conall Cole, IDC is a Student in an Organized Health Care Education/Training Program in Aguana, Guam. Works from 2 locations. Licensed in California.

Licensed in: CA
In the registry since: 2022
Specialties on file: 2

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Practice location Address may be wrong

The ZIP code does not match the city and state on this record. Call before visiting.

Uss Frank Cable Unit 100105
Aguana, GU 96567
Phone: (717) 601-4053

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Additional practice locations (1)

34101 Farenholt Ave Bldg 14, San Diego, CA 92134-7000 — (717) 601-4053

Specialties & licences

Independent Duty Corpsman (primary)	Taxonomy 1710I1002X
Student in an Organized Health Care Education/Training Program	Taxonomy 390200000X (CA)

Record details

NPI number	1871211748
Entity type	Individual (Type 1)
Gender	Male
Credentials	IDC
Sole proprietor	No
NPI enumerated	August 17, 2022
Last updated in NPPES	January 5, 2023
Certification date	January 3, 2023
Mailing address	Uss Frank Cable, Unit 100105 Box 216 Fpo, Ae 96567-0502, Aguana, GU 96567