Provider Demographics
NPI:1497974166
Name:COASTAL HEALTH CARE, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:COASTAL HEALTH CARE, A MEDICAL CORPORATION
Other - Org Name:COASTAL CARING FOR WOMEN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:805-815-4400
Mailing Address - Street 1:1216 BAYSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-2147
Mailing Address - Country:US
Mailing Address - Phone:805-815-4400
Mailing Address - Fax:805-815-4848
Practice Address - Street 1:2130 N VENTURA RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2258
Practice Address - Country:US
Practice Address - Phone:805-815-4400
Practice Address - Fax:805-815-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID