Provider Demographics
NPI:1396360194
Name:COAST TO COAST DME
Entity Type:Organization
Organization Name:COAST TO COAST DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:OTIKO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-836-2475
Mailing Address - Street 1:3355 N WHITE AVE UNIT 7310
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-6161
Mailing Address - Country:US
Mailing Address - Phone:909-223-3314
Mailing Address - Fax:909-592-0738
Practice Address - Street 1:1755 W HAMMER LN STE 2
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-2900
Practice Address - Country:US
Practice Address - Phone:800-869-9203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies