1548635915 NPI number — COASTAL SURGICAL PHYSICIAN-ASSISTANT PARTNERS

Table of content: (NPI 1548635915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548635915 NPI number — COASTAL SURGICAL PHYSICIAN-ASSISTANT PARTNERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL SURGICAL PHYSICIAN-ASSISTANT PARTNERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548635915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 CARLSBAD VILLAGE DR
Provider Second Line Business Mailing Address:
SUITE 108A #395
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92008-2900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-549-3284
Provider Business Mailing Address Fax Number:
760-637-5440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 CARLSBAD VILLAGE DR
Provider Second Line Business Practice Location Address:
SUITE 108A #395
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92008-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-549-3284
Provider Business Practice Location Address Fax Number:
760-637-5440
Provider Enumeration Date:
12/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CRESPO
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
N
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
619-549-3284

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  20A10547 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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