1790265445 NPI number — COASTAL CARDIOVASCULAR CARE INC

Table of content: (NPI 1790265445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790265445 NPI number — COASTAL CARDIOVASCULAR CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL CARDIOVASCULAR CARE INC
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:
1790265445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
477 N EL CAMINO REAL STE C204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENCINITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92024-1332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-230-2256
Provider Business Mailing Address Fax Number:
760-452-2664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 GARDEN VIEW CT STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-2478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-452-6334
Provider Business Practice Location Address Fax Number:
760-634-9755
Provider Enumeration Date:
08/21/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MEHBOOB
Authorized Official First Name:
SALMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
607-452-6334

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  A119955 , 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)





Copyright © 2007-2025 www.npivalidator.com