Provider Demographics
NPI:1376690636
Name:COAST RADIOLOGY IMAGING AND INTERVENTION INC
Entity Type:Organization
Organization Name:COAST RADIOLOGY IMAGING AND INTERVENTION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMPERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-364-7744
Mailing Address - Street 1:DEPT LA 21789
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-1789
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:949-263-1639
Practice Address - Street 1:27700 MEDICAL CENTER ROAD
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-364-7744
Practice Address - Fax:949-364-4233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ69493ZOtherBLUE SHIELD
CAZZZ69494ZOtherBLUE SHIELD
CAGR0104330Medicaid
CAZZZ69492ZOtherBLUE SHIELD
CAZZZ69494ZOtherBLUE SHIELD
CADF4424Medicare PIN