Provider Demographics
NPI:1083746358
Name:COASTAL SURGEONS
Entity Type:Organization
Organization Name:COASTAL SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-724-5352
Mailing Address - Street 1:3998 VISTA WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4500
Mailing Address - Country:US
Mailing Address - Phone:760-724-5352
Mailing Address - Fax:760-724-5447
Practice Address - Street 1:351 SANTA FE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5137
Practice Address - Country:US
Practice Address - Phone:760-634-2411
Practice Address - Fax:760-634-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty