Provider Demographics
NPI:1053317826
Name:COAST NEPHROLOGY MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:COAST NEPHROLOGY MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:ERLBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-595-7426
Mailing Address - Street 1:3780 KILROY AIRPORT WAY
Mailing Address - Street 2:STE 115
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2458
Mailing Address - Country:US
Mailing Address - Phone:562-595-7426
Mailing Address - Fax:562-989-3054
Practice Address - Street 1:3780 KILROY AIRPORT WAY
Practice Address - Street 2:STE 115
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2458
Practice Address - Country:US
Practice Address - Phone:562-595-7426
Practice Address - Fax:562-989-3054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABU94027460207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0055750Medicaid
CAW12019AMedicare ID - Type Unspecified