Provider Demographics
NPI:1164283180
Name:COASTLINE PEDIATRIC CARDIOLOGY, P.C.
Entity Type:Organization
Organization Name:COASTLINE PEDIATRIC CARDIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-262-3351
Mailing Address - Street 1:1401 21ST ST STE R
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5226
Mailing Address - Country:US
Mailing Address - Phone:914-262-3351
Mailing Address - Fax:
Practice Address - Street 1:4425 JAMBOREE RD STE 129
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3002
Practice Address - Country:US
Practice Address - Phone:914-262-3351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty