Provider Demographics
NPI:1083273684
Name:COASTAL SKIN AND EYE INSTITUTE, INC.
Entity Type:Organization
Organization Name:COASTAL SKIN AND EYE INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-943-2540
Mailing Address - Street 1:5550 CARMEL MOUNTAIN RD STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4861
Mailing Address - Country:US
Mailing Address - Phone:858-943-2540
Mailing Address - Fax:858-252-2053
Practice Address - Street 1:477 N EL CAMINO REAL STE C300
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1356
Practice Address - Country:US
Practice Address - Phone:760-257-5550
Practice Address - Fax:858-252-2053
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL SKIN & EYE INSTITUTE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-07
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty