Provider Demographics
NPI:1205390549
Name:COAST NEUROLOGY AND WELLNESS CLINIC LLC
Entity Type:Organization
Organization Name:COAST NEUROLOGY AND WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULI
Authorized Official - Middle Name:
Authorized Official - Last Name:PUCHEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-436-1649
Mailing Address - Street 1:1903 PASS RD STE A
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4120
Mailing Address - Country:US
Mailing Address - Phone:228-436-1649
Mailing Address - Fax:228-436-1664
Practice Address - Street 1:1903 PASS RD STE A
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4120
Practice Address - Country:US
Practice Address - Phone:228-436-1649
Practice Address - Fax:228-436-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty