Provider Demographics
NPI:1346831187
Name:COASTALMED MEDICAL SERVICES, LLC.
Entity Type:Organization
Organization Name:COASTALMED MEDICAL SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-393-8647
Mailing Address - Street 1:74998 COUNTRY CLUB DR STE 220-510
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-1970
Mailing Address - Country:US
Mailing Address - Phone:951-393-8647
Mailing Address - Fax:
Practice Address - Street 1:74998 COUNTRY CLUB DR STE 220-510
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1970
Practice Address - Country:US
Practice Address - Phone:951-393-8647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport