Provider Demographics
NPI:1457313884
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:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:REINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-755-6055
Mailing Address - Street 1:550 LOMAS SANTA FE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1343
Mailing Address - Country:US
Mailing Address - Phone:858-755-6055
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:92075-1343
Practice Address - Country:US
Practice Address - Phone:858-755-6055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4395620001Medicare NSC
CAW15295Medicare PIN