Provider Demographics
NPI:1376769133
Name:COASTAL PSYCHIATRIC CARE, AMC
Entity Type:Organization
Organization Name:COASTAL PSYCHIATRIC CARE, AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUGALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHISHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-466-5626
Mailing Address - Street 1:8575 MORRO RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-3924
Mailing Address - Country:US
Mailing Address - Phone:805-466-5626
Mailing Address - Fax:805-466-2322
Practice Address - Street 1:8575 MORRO RD
Practice Address - Street 2:SUITE K
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3924
Practice Address - Country:US
Practice Address - Phone:805-466-5626
Practice Address - Fax:805-466-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty