Provider Demographics
NPI:1184208001
Name:COASTAL PHYSICAL MEDICINE AND REHABILITATION INC.
Entity Type:Organization
Organization Name:COASTAL PHYSICAL MEDICINE AND REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-906-3072
Mailing Address - Street 1:270 N EL CAMINO REAL # F-512
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2874
Mailing Address - Country:US
Mailing Address - Phone:951-315-8689
Mailing Address - Fax:877-986-6999
Practice Address - Street 1:354 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5142
Practice Address - Country:US
Practice Address - Phone:760-906-3072
Practice Address - Fax:877-986-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty