Provider Demographics
NPI:1386677011
Name:WEST COAST OB/GYN
Entity Type:Organization
Organization Name:WEST COAST OB/GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE DEPARTMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELNAHWY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-745-1616
Mailing Address - Street 1:513 MANATEE AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1145
Mailing Address - Country:US
Mailing Address - Phone:941-745-1616
Mailing Address - Fax:941-748-1443
Practice Address - Street 1:513 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1145
Practice Address - Country:US
Practice Address - Phone:941-745-1616
Practice Address - Fax:941-748-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0040777174400000X
FL0073879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41216Medicare ID - Type Unspecified
FL42625Medicare ID - Type Unspecified