Provider Demographics
NPI:1083179360
Name:COASTAL HEALTH ALLIANCE
Entity Type:Organization
Organization Name:COASTAL HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DINELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ABRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-663-8781
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:POINT REYES STATION
Mailing Address - State:CA
Mailing Address - Zip Code:94956-0910
Mailing Address - Country:US
Mailing Address - Phone:415-663-8781
Mailing Address - Fax:
Practice Address - Street 1:65 THIRD STREET
Practice Address - Street 2:SUITE 13
Practice Address - City:POINT REYES STATION
Practice Address - State:CA
Practice Address - Zip Code:94956
Practice Address - Country:US
Practice Address - Phone:415-787-1123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental