Provider Demographics
NPI:1326337270
Name:COASTAL VIEW GASTROENTEROLOGY OF SOUTH BAY
Entity Type:Organization
Organization Name:COASTAL VIEW GASTROENTEROLOGY OF SOUTH BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SACHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-560-0695
Mailing Address - Street 1:3440 LOMITA BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:424-250-9179
Mailing Address - Fax:323-300-2021
Practice Address - Street 1:3440 LOMITA BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4801
Practice Address - Country:US
Practice Address - Phone:310-997-1796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL VIEW GASTROENTEROLOGY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-31
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85817207RG0100X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty