Provider Demographics
NPI:1093132904
Name:COASTAL SPINE & ORTHOPEDIC ASSOCIATES
Entity Type:Organization
Organization Name:COASTAL SPINE & ORTHOPEDIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M,D./MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-933-7012
Mailing Address - Street 1:3420 BRISTOL ST STE 700
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7137
Mailing Address - Country:US
Mailing Address - Phone:949-933-7012
Mailing Address - Fax:949-387-3380
Practice Address - Street 1:3420 BRISTOL ST STE 700
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7137
Practice Address - Country:US
Practice Address - Phone:949-933-7012
Practice Address - Fax:949-387-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty