Provider Demographics
NPI:1326109604
Name:COASTAL CENTER FOR OBESITY
Entity Type:Organization
Organization Name:COASTAL CENTER FOR OBESITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN AND SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:L
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-833-4448
Mailing Address - Street 1:1094 W. 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2928
Mailing Address - Country:US
Mailing Address - Phone:310-833-4448
Mailing Address - Fax:310-833-1146
Practice Address - Street 1:1094 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2928
Practice Address - Country:US
Practice Address - Phone:310-833-4448
Practice Address - Fax:310-833-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAI-107334-L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty