Provider Demographics
NPI:1114119393
Name:COASTAL AESTHETIC CENTER PA
Entity Type:Organization
Organization Name:COASTAL AESTHETIC CENTER PA
Other - Org Name:HARMONY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANH
Authorized Official - Middle Name:
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-245-1320
Mailing Address - Street 1:PO BOX 3123
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3123
Mailing Address - Country:US
Mailing Address - Phone:904-245-1320
Mailing Address - Fax:866-878-2261
Practice Address - Street 1:301 HEALTH PARK BLVD
Practice Address - Street 2:STE 109
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5794
Practice Address - Country:US
Practice Address - Phone:904-245-1320
Practice Address - Fax:866-878-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME990622086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN9242OtherRR MDCR
FL01507OtherFL BLUE
FLAG541Medicare PIN