Provider Demographics
NPI:1538701560
Name:COAST MEDICAL PROFESSIONALS ALLIANCE, IPA
Entity Type:Organization
Organization Name:COAST MEDICAL PROFESSIONALS ALLIANCE, IPA
Other - Org Name:APEX MEDICAL PROFESSIONALS ALLIANCE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-754-1684
Mailing Address - Street 1:2621 S BRISTOL ST STE 306
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5765
Mailing Address - Country:US
Mailing Address - Phone:714-754-1684
Mailing Address - Fax:
Practice Address - Street 1:2621 S BRISTOL ST STE 306
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5765
Practice Address - Country:US
Practice Address - Phone:714-754-1684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization