Provider Demographics
NPI:1497013627
Name:COAST PEDIATRICS DEL MAR
Entity Type:Organization
Organization Name:COAST PEDIATRICS DEL MAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-335-5043
Mailing Address - Street 1:12845 POINTE DEL MAR WAY
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3862
Mailing Address - Country:US
Mailing Address - Phone:858-794-7337
Mailing Address - Fax:858-777-5492
Practice Address - Street 1:12845 POINTE DEL MAR WAY
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3862
Practice Address - Country:US
Practice Address - Phone:858-794-7337
Practice Address - Fax:858-777-5492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty