Provider Demographics
NPI:1437436185
Name:COAST PODIATRY GROUP OF SOLANA BEACH INC.
Entity Type:Organization
Organization Name:COAST PODIATRY GROUP OF SOLANA BEACH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:REINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:858-755-6055
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:550 LOMAS SANTA FE DR
Practice Address - Street 2:SUITE B
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1341
Practice Address - Country:US
Practice Address - Phone:858-755-6055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COAST PODIATRY GROUP OF SOLANA BEACH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site